Healthcare Provider Details

I. General information

NPI: 1659935385
Provider Name (Legal Business Name): HYO JUNG YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 POPLAR RD STE 250
NEWNAN GA
30265-8303
US

IV. Provider business mailing address

775 POPLAR RD STE 250
NEWNAN GA
30265-8303
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-7860
  • Fax:
Mailing address:
  • Phone: 678-423-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number112910
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.152942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: