Provider Demographics
NPI:1043057763
Name:JAE, HYUN A (PHARMD)
Entity type:Individual
Prefix:
First Name:HYUN A
Middle Name:
Last Name:JAE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:JAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:121 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5493
Mailing Address - Country:US
Mailing Address - Phone:718-250-8000
Mailing Address - Fax:
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5493
Practice Address - Country:US
Practice Address - Phone:718-250-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist