Provider Demographics
NPI:1740332840
Name:YUN, INCHOL
Entity type:Individual
Prefix:DR
First Name:INCHOL
Middle Name:
Last Name:YUN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:INCHOL
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:3575 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1027
Practice Address - Country:US
Practice Address - Phone:770-848-5300
Practice Address - Fax:770-848-5301
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBSWDMedicare PIN
GAF49198Medicare UPIN