Provider Demographics
NPI:1699737254
Name:KOO, JIHYUN (MD)
Entity type:Individual
Prefix:
First Name:JIHYUN
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONEFOREST DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4880
Mailing Address - Country:US
Mailing Address - Phone:770-516-5199
Mailing Address - Fax:770-516-5188
Practice Address - Street 1:100 STONEFOREST DR
Practice Address - Street 2:SUITE 320
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4880
Practice Address - Country:US
Practice Address - Phone:770-516-5199
Practice Address - Fax:770-516-5188
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG82321Medicare UPIN
GAG82321Medicare UPIN