Provider Demographics
NPI:1376736702
Name:SUNG YANG DC, PC
Entity Type:Organization
Organization Name:SUNG YANG DC, PC
Other - Org Name:KIM FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-451-4011
Mailing Address - Street 1:5715 BUFORD HWY NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1229
Mailing Address - Country:US
Mailing Address - Phone:770-451-4011
Mailing Address - Fax:770-451-1065
Practice Address - Street 1:5715 BUFORD HWY NE
Practice Address - Street 2:SUITE 204
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1229
Practice Address - Country:US
Practice Address - Phone:770-451-4011
Practice Address - Fax:770-451-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9150110OtherPHCS
GA650378OtherACN GROUP
GA35ZCHGSMedicare PIN