Provider Demographics
NPI:1104922590
Name:HAHM, SUSAN JUNGHEE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JUNGHEE
Last Name:HAHM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:751 W LEGION RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7732
Mailing Address - Country:US
Mailing Address - Phone:760-351-0025
Mailing Address - Fax:760-344-6954
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-351-0025
Practice Address - Fax:760-344-6954
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA97007208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104922590Medicaid
CA1104922590Medicare PIN