Provider Demographics
NPI:1043403462
Name:YANG, SUNG H (DC)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:H
Last Name:YANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 OLD PEACHTREE RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2028
Mailing Address - Country:US
Mailing Address - Phone:770-882-6666
Mailing Address - Fax:770-252-6800
Practice Address - Street 1:1299 OLD PEACHTREE RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2028
Practice Address - Country:US
Practice Address - Phone:770-882-6666
Practice Address - Fax:770-252-6800
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006876111N00000X
GAGA006876111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9150110OtherPHCS
GA650378OtherACN GROUP, PROVIDER #
GA35ZCHGSMedicare PIN