MEDICARE: DR. SUNG H YANG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006876	GA
2	111NN1001X	Nutrition Chiropractor	GA006876	GA
3	111NR0400X	Rehabilitation Chiropractor	GA006876	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9150110	OTHER	GA	PHCS
2	650378	OTHER	GA	ACN GROUP, PROVIDER #

General Provider Information

NPI Number	:	1043403462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG H YANG D.C.

Provider Business Mailing Address
First Line	:	1299 OLD PEACHTREE RD NW
Second Line	:	SUITE 101
City	:	SUWANEE
State	:	GA
Zip	:	30024-2028
Country	:	US
Telephone Number	:	770-882-6666
Fax Number	:	770-252-6800

Provider Business Practice Location Address
First Line	:	1299 OLD PEACHTREE RD NW
Second Line	:	SUITE 101
City	:	SUWANEE
State	:	GA
Zip	:	30024-2028
Country	:	US
Telephone Number	:	770-882-6666
Fax Number	:	770-252-6800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	07/19/2011

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Directions to “ DR. SUNG H YANG D.C.” Practice Location

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