Healthcare Provider Details

I. General information

NPI: 1477540664
Provider Name (Legal Business Name): DAE SOO BHYUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

629D LOWTHER RD
LEWISBERRY PA
17339-9527
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-4624
  • Fax: 717-851-3431
Mailing address:
  • Phone: 717-932-5218
  • Fax: 717-932-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD030019L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: