Provider Demographics
NPI:1073701314
Name:SUK KYUN HAHN MD MAC
Entity Type:Organization
Organization Name:SUK KYUN HAHN MD MAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUK KYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD MAC
Authorized Official - Phone:410-821-5610
Mailing Address - Street 1:1300 YORK ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-821-5610
Mailing Address - Fax:410-821-5809
Practice Address - Street 1:1300 YORK ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-821-5610
Practice Address - Fax:410-821-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00578171100000X
MD400578171100000X
MDD0037449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD070461000Medicaid
MD3063Medicare PIN
MDE56401Medicare UPIN