Healthcare Provider Details

I. General information

NPI: 1477819324
Provider Name (Legal Business Name): HAHN SOE-LIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date: 09/11/2018
Reactivation Date: 11/14/2018

III. Provider practice location address

500 W THOMAS RD STE 400
PHOENIX AZ
85013-4238
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3874
  • Fax: 602-406-2335
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number57786
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number57786
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: