Provider Demographics
NPI:1013221324
Name:HAN, JAMES BUM-SUK (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BUM-SUK
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREGORY LANE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-689-8500
Mailing Address - Fax:
Practice Address - Street 1:401 GREGORY LANE
Practice Address - Street 2:SUITE 208
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-689-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD100039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN190001076Medicare PIN