Healthcare Provider Details

I. General information

NPI: 1669680401
Provider Name (Legal Business Name): BYOL SHIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/14/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30044-4609
US

IV. Provider business mailing address

10600 MEDLOCK BRIDGE RD
DULUTH GA
30097-8404
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-5695
  • Fax: 678-205-8210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number061163
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: