Provider Demographics
NPI:1043233711
Name:HAHN, SEUNG SHIN (MD)
Entity Type:Individual
Prefix:
First Name:SEUNG SHIN
Middle Name:
Last Name:HAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PRESIDENTIAL PLZ
Mailing Address - Street 2:MADISON TOWERS SUITE 208
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2292
Mailing Address - Country:US
Mailing Address - Phone:315-464-2020
Mailing Address - Fax:315-464-2025
Practice Address - Street 1:1000 EAST GENESEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-476-3535
Practice Address - Fax:315-476-4140
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1985722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198572OtherNYS LICENSE
NY01581777Medicaid
BB1901Medicare ID - Type Unspecified
NY198572OtherNYS LICENSE