Provider Demographics
NPI:1043280514
Name:HAN, SUN-TAK (MD)
Entity Type:Individual
Prefix:DR
First Name:SUN-TAK
Middle Name:
Last Name:HAN
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0430
Mailing Address - Country:US
Mailing Address - Phone:570-586-3982
Mailing Address - Fax:570-585-2896
Practice Address - Street 1:105 LAYTON RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9376
Practice Address - Country:US
Practice Address - Phone:570-586-3982
Practice Address - Fax:570-585-2896
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036654L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18827OtherGEISINGER HEALTH
PA800080OtherFIRST PRIORITY HEALTH
C29658Medicare UPIN
93332Medicare ID - Type Unspecified