| Organization Name: | KO-AM GWINNETT MEDICAL |
| NPI Number: | 1588935589 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONG SANG WON (OWNER) |
| Mailing Address: | 6062 Buford Hwy Suite 114 Norcross |
| State: | GA US |
| Postal Code: | 300712424 |
| Phone Number: | 7705570203 |
| Fax Number: | 6783955453 |
| NPI Enumeration Date: | 01/23/2012 |
| NPI Last Update Date: | 08/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |