Healthcare Provider Details

I. General information

NPI: 1235549270
Provider Name (Legal Business Name): PAUL HYUNSOO YI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL DEPT OF
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

22 S GREENE ST DEPT OF RADIOLOGY
BALTIMORE MD
21201-1542
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone: 410-328-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6472-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD85195
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number72312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: