Provider Demographics
NPI:1497108963
Name:HALL-AUSTIN, KAYAN
Entity Type:Individual
Prefix:
First Name:KAYAN
Middle Name:
Last Name:HALL-AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13456 241ST ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1471
Mailing Address - Country:US
Mailing Address - Phone:718-348-2053
Mailing Address - Fax:
Practice Address - Street 1:13456 241ST ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1471
Practice Address - Country:US
Practice Address - Phone:718-348-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695879961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist