Provider Demographics
NPI:1811354970
Name:HAM, YOUNG YOON
Entity type:Individual
Prefix:
First Name:YOUNG YOON
Middle Name:
Last Name:HAM
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 1:6785 NW MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9119
Mailing Address - Country:US
Mailing Address - Phone:860-575-3466
Mailing Address - Fax:
Practice Address - Street 1:6785 NW MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9119
Practice Address - Country:US
Practice Address - Phone:860-575-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0011961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist