Healthcare Provider Details

I. General information

NPI: 1104338979
Provider Name (Legal Business Name): HANNAH MYUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD STE E4.300
DALLAS TX
75390-8579
US

IV. Provider business mailing address

6124 WEST PARKER ROAD BUILDING 3 SUITE 530
PLANO TX
75093-8140
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3916
  • Fax: 214-648-8423
Mailing address:
  • Phone: 214-778-1075
  • Fax: 214-778-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: