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General NPI Number Information
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NPI Number | 1255834974
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Entity Type | Individual
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Provider Name | JAE HUN SON DO
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Gender | Male
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 445 CARRIAGE CT
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City | ALPHARETTA
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State | GA
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Zip | 30022-6682
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Country | US
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Telephone | 678-897-7550
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Fax | 540-779-7808
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Provider Business Mailing Address
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Address Line | 445 CARRIAGE CT
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City | ALPHARETTA
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State | GA
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Zip | 30022-6682
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Country | US
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Telephone | 678-897-7550
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Fax | 540-779-7808
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 98831
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34.014293
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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