Provider Demographics
NPI:1588061972
Name:UM, LINDSAY HYEJIN
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:HYEJIN
Last Name:UM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 54TH ST APT 7P
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4217
Mailing Address - Country:US
Mailing Address - Phone:347-832-8012
Mailing Address - Fax:
Practice Address - Street 1:3960 54TH ST APT 7P
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4217
Practice Address - Country:US
Practice Address - Phone:347-832-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist