Provider Demographics
NPI:1861526287
Name:HAHN, SEGENE KI YOUNG
Entity type:Individual
Prefix:DR
First Name:SEGENE
Middle Name:KI YOUNG
Last Name:HAHN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GENE
Other - Middle Name:K
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6735 CASCADE RD SE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6887
Mailing Address - Country:US
Mailing Address - Phone:616-262-4611
Mailing Address - Fax:616-975-1545
Practice Address - Street 1:6735 CASCADE RD SE
Practice Address - Street 2:SUITE #400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6887
Practice Address - Country:US
Practice Address - Phone:616-262-4611
Practice Address - Fax:616-975-1545
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010175541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427885OtherEMPLOYER MESC #
MI2901017554OtherMICHIGAN DENTAL LICENSE #
MIB4064EOtherCORP. DIVISION ID #
MI0001950001OtherUNEMPLOYMT AGENCY #
MI0001950001OtherUNEMPLOYMT AGENCY #
MI2901017554OtherMICHIGAN DENTAL LICENSE #