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General NPI Number Information
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NPI Number | 1902883143
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Entity Type | Individual
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Provider Name | IA Y KUE D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 115 LEE BYRD RD
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City | LOGANVILLE
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State | GA
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Zip | 30052-2310
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Country | US
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Telephone | 707-554-4717
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Fax | 770-554-4681
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Provider Business Mailing Address
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Address Line | 115 LEE BYRD RD
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City | LOGANVILLE
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State | GA
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Zip | 30052-2310
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Country | US
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Telephone | 707-554-4717
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Fax | 770-554-4681
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101015717
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95143
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License Number State | GA
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