Provider Demographics
NPI:1912187188
Name:HE, KEDONG (DC)
Entity Type:Individual
Prefix:DR
First Name:KEDONG
Middle Name:
Last Name:HE
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 1:4897 BUFORD HWY
Mailing Address - Street 2:SUITE 166
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3667
Mailing Address - Country:US
Mailing Address - Phone:770-457-0641
Mailing Address - Fax:770-457-0642
Practice Address - Street 1:4897 BUFORD HWY
Practice Address - Street 2:SUITE 166
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3667
Practice Address - Country:US
Practice Address - Phone:770-457-0641
Practice Address - Fax:770-457-0642
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005054111NN1001X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician