1487703310 NPI number — HAE YOON KWON P.T.

Table of content: ALLISON M HERRING M.S., R.D. (NPI 1538313382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487703310 NPI number — HAE YOON KWON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWON
Provider First Name:
HAE
Provider Middle Name:
YOON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISHOP
Provider Other First Name:
HAE
Provider Other Middle Name:
KWON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487703310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2953 PELHAM PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35124-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-624-2436
Provider Business Mailing Address Fax Number:
205-624-2439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 ALFORD AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35226-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-824-8850
Provider Business Practice Location Address Fax Number:
205-824-8853
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH3962 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051513721KWO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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