Provider Demographics
NPI:1487934725
Name:MCMAHAN, HWA SON
Entity type:Individual
Prefix:
First Name:HWA
Middle Name:SON
Last Name:MCMAHAN
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 1:14330 SANFORD AVE
Mailing Address - Street 2:6H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2047
Mailing Address - Country:US
Mailing Address - Phone:718-475-8820
Mailing Address - Fax:
Practice Address - Street 1:14330 SANFORD AVE
Practice Address - Street 2:6H
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2047
Practice Address - Country:US
Practice Address - Phone:718-475-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse