Provider Demographics
NPI:1053819235
Name:JANG, SEAN WONSUK (DC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:WONSUK
Last Name:JANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 LAWRENCEVILLE SUWANEE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6569
Mailing Address - Country:US
Mailing Address - Phone:678-889-2594
Mailing Address - Fax:678-392-2481
Practice Address - Street 1:3370 LAWRENCEVILLE SUWANEE RD STE 118
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-889-2594
Practice Address - Fax:678-392-2481
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009655111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner