Healthcare Provider Details

I. General information

NPI: 1295744001
Provider Name (Legal Business Name): SUNG-UP HAHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CHAPEL GATE LN
BALTIMORE MD
21229-3906
US

IV. Provider business mailing address

1604 TIMBERLINE CT
TOWSON MD
21286-1540
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-7754
  • Fax:
Mailing address:
  • Phone: 410-296-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0012852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: