Provider Demographics
NPI:1295846855
Name:YI, KATHERINE KYUNGAE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KYUNGAE
Last Name:YI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 SUWANEE BEND DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6452
Mailing Address - Country:US
Mailing Address - Phone:678-541-6020
Mailing Address - Fax:
Practice Address - Street 1:302 SATELLITE BLVD NE STE 216
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7185
Practice Address - Country:US
Practice Address - Phone:678-541-6020
Practice Address - Fax:678-541-6023
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice