Provider Demographics
NPI:1538893805
Name:CHOI, SANG HYUN
Entity type:Individual
Prefix:
First Name:SANG HYUN
Middle Name:
Last Name:CHOI
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 1:1525 LAUREL CROSSING PKWY APT 618
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6578
Mailing Address - Country:US
Mailing Address - Phone:310-844-4000
Mailing Address - Fax:
Practice Address - Street 1:5641 US HIGHWAY 129 N # 34
Practice Address - Street 2:
Practice Address - City:PENDERGRASS
Practice Address - State:GA
Practice Address - Zip Code:30567-4714
Practice Address - Country:US
Practice Address - Phone:310-844-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14007171100000X
GA494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist