Provider Demographics
NPI:1710280656
Name:NEW GYN LLC
Entity Type:Organization
Organization Name:NEW GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:KYU
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-670-6551
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD.
Mailing Address - Street 2:275
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-670-6551
Mailing Address - Fax:770-670-6507
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:275
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:770-670-6551
Practice Address - Fax:770-670-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015637261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center