Provider Demographics
NPI:1992941314
Name:HAGO, WEYMIN (MD)
Entity type:Individual
Prefix:
First Name:WEYMIN
Middle Name:
Last Name:HAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 73RD ST
Mailing Address - Street 2:APT 6F
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 PARK AVE S
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7320
Practice Address - Country:US
Practice Address - Phone:646-688-3145
Practice Address - Fax:646-626-7555
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY00695941Medicaid
NY331978Medicare Oscar/Certification