Provider Demographics
NPI:1063138717
Name:JAE, BYUNG
Entity type:Individual
Prefix:
First Name:BYUNG
Middle Name:
Last Name:JAE
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 1:1325 SATELLITE BLVD NW STE 601
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4709
Mailing Address - Country:US
Mailing Address - Phone:770-817-3399
Mailing Address - Fax:770-817-2555
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 601
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4709
Practice Address - Country:US
Practice Address - Phone:770-817-3399
Practice Address - Fax:770-817-2555
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor