New GYN LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

015637 Issued in GA

Legal business name

NEW GYN LLC

Practice address

3840 Peachtree Industrial Blvd
275
Duluth, GA 30096-5031

Phone

(770) 670-6551

Fax

(770) 670-6507

NPI assigned

Dec 15, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jong Kyu Song, M.D.

Title

Doctor

Phone

(770) 670-6551

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1710280656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 PEACHTREE INDUSTRIAL BLVD.",
            "address_2": "275",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "770-670-6551",
            "fax_number": "770-670-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "275",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965031",
            "telephone_number": "770-670-6551",
            "fax_number": "770-670-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW GYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "JONG",
        "authorized_official_middle_name": "KYU",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "770-670-6551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "015637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Duluth, GA
• Providers in Duluth, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.