Healthcare Provider Details

I. General information

NPI: 1689761637
Provider Name (Legal Business Name): HYUN CHUL TAE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W FRONTIER LN
OLATHE KS
66061-7221
US

IV. Provider business mailing address

11901 W 109TH ST APT 212
OVERLAND PARK KS
66210-3977
US

V. Phone/Fax

Practice location:
  • Phone: 833-307-1517
  • Fax:
Mailing address:
  • Phone: 850-938-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6911
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-15721
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302036696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: