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General NPI Number Information
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NPI Number | 1235770744
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Entity Type | Individual
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Provider Name | PYUNG GANG CHO LAC
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Gender | Female
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 11180 STATE BRIDGE RD STE 205
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City | JOHNS CREEK
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State | GA
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Zip | 30022-7483
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Country | US
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Telephone | 770-703-9939
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Fax |
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Provider Business Mailing Address
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Address Line | 5192 LOWER CREEK ST
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-2395
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Country | US
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Telephone | 347-331-7237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 006560
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 516
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License Number State | GA
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