Healthcare Provider Details

I. General information

NPI: 1053614263
Provider Name (Legal Business Name): BAHN YAH MOON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PARK AVE SUITE 1G
NEW YORK NY
10065-8015
US

IV. Provider business mailing address

530 PARK AVE SUITE 1G
NEW YORK NY
10065-8015
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-0040
  • Fax:
Mailing address:
  • Phone: 212-758-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number050664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: