Healthcare Provider Details

I. General information

NPI: 1467486761
Provider Name (Legal Business Name): KYUNG OH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 BUFORD HWY # 202
DORAVILLE GA
30340
US

IV. Provider business mailing address

5441 BUFORD HWY # 202
DORAVILLE GA
30340
US

V. Phone/Fax

Practice location:
  • Phone: 770-451-7848
  • Fax:
Mailing address:
  • Phone: 770-451-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8696
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: