Healthcare Provider Details

I. General information

NPI: 1265634273
Provider Name (Legal Business Name): YOUNGCHOON JOSEPH FISCHER HAHM D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YOUNGCHOON FISCHER HAHM D.M.D.

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE STE 200
RIO RANCHO NM
87124-1045
US

IV. Provider business mailing address

5016 COSTA UASCA DR NW
ALBUQUERQUE NM
87120-5790
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-9693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4940
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: