Provider Demographics
NPI:1588864052
Name:WOO, SUNG-YUN
Entity type:Individual
Prefix:
First Name:SUNG-YUN
Middle Name:
Last Name:WOO
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 1:4930 GOVERNORS DR
Mailing Address - Street 2:STE 405
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6101
Mailing Address - Country:US
Mailing Address - Phone:404-363-1700
Mailing Address - Fax:850-837-2042
Practice Address - Street 1:4930 GOVERNORS DR
Practice Address - Street 2:STE 405
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6101
Practice Address - Country:US
Practice Address - Phone:404-363-1700
Practice Address - Fax:850-837-2042
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice