=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881264638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YELIN HA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2021
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 RED MILLS RD
-----------------------------------------------------
City | WALLKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12589-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-744-9105
-----------------------------------------------------
Fax | 845-744-9107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 RED MILLS RD
-----------------------------------------------------
City | WALLKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12589-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-744-9105
-----------------------------------------------------
Fax | 845-744-9107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019.033231
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 064543
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------