Provider Demographics
NPI:1861838112
Name:YOON, HANNAH (LAC MSTOM)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:LAC MSTOM
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:LAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:404 FOURTH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1210
Mailing Address - Country:US
Mailing Address - Phone:917-597-6595
Mailing Address - Fax:
Practice Address - Street 1:342 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1204
Practice Address - Country:US
Practice Address - Phone:917-597-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist