Healthcare Provider Details

I. General information

NPI: 1730006636
Provider Name (Legal Business Name): YJN DIAMONDLINE HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 STATE BRIDGE RD STE G74
JOHNS CREEK GA
30097-8220
US

IV. Provider business mailing address

5805 STATE BRIDGE RD STE G74
JOHNS CREEK GA
30097-8220
US

V. Phone/Fax

Practice location:
  • Phone: 786-509-5082
  • Fax:
Mailing address:
  • Phone: 786-509-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: OLGENS CYRUS
Title or Position: OWNER
Credential:
Phone: 786-509-5082