Healthcare Provider Details

I. General information

NPI: 1568320109
Provider Name (Legal Business Name): YEUNIE KO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 INTERNATIONAL BLVD STE B101
NORCROSS GA
30093-3013
US

IV. Provider business mailing address

4405 INTERNATIONAL BLVD STE B101
NORCROSS GA
30093-3013
US

V. Phone/Fax

Practice location:
  • Phone: 770-558-2297
  • Fax:
Mailing address:
  • Phone: 770-558-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN190213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: