Provider Demographics
NPI:1942033014
Name:HONG, JIEUN (DMD)
Entity type:Individual
Prefix:
First Name:JIEUN
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FAVOR RD # ATP7301
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7750
Mailing Address - Country:US
Mailing Address - Phone:770-875-9888
Mailing Address - Fax:
Practice Address - Street 1:1001 N PEACHTREE PKWY STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4210
Practice Address - Country:US
Practice Address - Phone:770-875-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist