Healthcare Provider Details

I. General information

NPI: 1730121120
Provider Name (Legal Business Name): SAE JOON HAHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE STE 102
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

6 RESEARCH DR STE 105
SHELTON CT
06484-6228
US

V. Phone/Fax

Practice location:
  • Phone: 845-822-8100
  • Fax: 845-822-8110
Mailing address:
  • Phone: 203-210-6340
  • Fax: 203-502-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number054931
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number262299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: