MEDICARE: HYOCHOL AHN APRN, ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	905466	TX
2	363LA2200X	Adult Health Nurse Practitioner	AP131758	TX

General Provider Information

NPI Number	:	1093240590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYOCHOL AHN APRN, ANP-BC

Provider Business Mailing Address
First Line	:	17727 BALINTORE LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4531
Country	:	US
Telephone Number	:	352-792-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 BERTNER AVE # SON539A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3901
Country	:	US
Telephone Number	:	713-500-2179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2017
Last Update Date	:	04/22/2017

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