Provider Demographics
NPI:1518657360
Name:KYE, HAE
Entity Type:Individual
Prefix:
First Name:HAE
Middle Name:
Last Name:KYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAE
Other - Middle Name:KYUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 114TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1439
Mailing Address - Country:US
Mailing Address - Phone:646-355-7647
Mailing Address - Fax:
Practice Address - Street 1:1419 114TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1439
Practice Address - Country:US
Practice Address - Phone:646-355-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1719690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist