Provider Demographics
NPI:1952970972
Name:YANG, KYONGHWAN
Entity Type:Individual
Prefix:
First Name:KYONGHWAN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 AZTEC RD APT 14D
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5713
Mailing Address - Country:US
Mailing Address - Phone:770-896-1536
Mailing Address - Fax:
Practice Address - Street 1:5441 BUFORD HWY NE STE 203
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1168
Practice Address - Country:US
Practice Address - Phone:770-451-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA464171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist