Provider Demographics
NPI:1053689133
Name:CHAN S HAN MD PA
Entity Type:Organization
Organization Name:CHAN S HAN MD PA
Other - Org Name:DHAN S HAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:620-251-1560
Mailing Address - Street 1:908 SIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-2921
Mailing Address - Country:US
Mailing Address - Phone:620-251-1560
Mailing Address - Fax:620-251-8144
Practice Address - Street 1:908 SIGGINS ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-2921
Practice Address - Country:US
Practice Address - Phone:620-251-1560
Practice Address - Fax:620-251-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15718302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization