Individual
YONG-SON BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
STAMFORD HOSPITAL, 30 SHELBURNE RD, DEPARTMENT OF PEDIATRICS, STAMFORD, CT 06904-9317
(203) 276-7051
(203) 276-7363
Mailing address
57 HICKOK RD, NEW CANAAN, CT 06840-3304
(203) 972-3357
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036501
CT
208000000X
Pediatrics Physician
1273
VI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001365015
—
CT
Enumeration date
02/02/2007
Last updated
07/08/2007
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