Provider Demographics
NPI:1770535718
Name:SYLVA WOMEN'S CLINIC PA
Entity type:Organization
Organization Name:SYLVA WOMEN'S CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWANG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-586-4096
Mailing Address - Street 1:111 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NY
Mailing Address - Zip Code:28779
Mailing Address - Country:US
Mailing Address - Phone:828-586-4096
Mailing Address - Fax:828-586-1064
Practice Address - Street 1:111 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NY
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-586-4096
Practice Address - Fax:828-586-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016AVMedicaid
NC016AVOtherBCBS
NC89016AVMedicaid