Healthcare Provider Details

I. General information

NPI: 1891140240
Provider Name (Legal Business Name): JUSTIN YOON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 DULUTH HWY SUITE 401
LAWRENCEVILLE GA
30046-3328
US

IV. Provider business mailing address

4441 ATLANTA RD SE STE 107
SMYRNA GA
30080-6431
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-4072
  • Fax: 678-312-0423
Mailing address:
  • Phone: 470-956-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80246
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: