Healthcare Provider Details

I. General information

NPI: 1023272630
Provider Name (Legal Business Name): HONG YIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 BROADWAY 12TH FLOOR
NEW YORK NY
10003-4709
US

IV. Provider business mailing address

255 E 49TH ST APT. 6B
NEW YORK NY
10017-1500
US

V. Phone/Fax

Practice location:
  • Phone: 212-473-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number052736-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: