Provider Demographics
NPI:1134127293
Name:HAN, NYUN CALVIN (MD)
Entity Type:Individual
Prefix:
First Name:NYUN
Middle Name:CALVIN
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 1:7420 REMCON CIR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3537
Mailing Address - Country:US
Mailing Address - Phone:915-532-8823
Mailing Address - Fax:915-532-5909
Practice Address - Street 1:7420 REMCON CIR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3537
Practice Address - Country:US
Practice Address - Phone:915-532-8823
Practice Address - Fax:915-532-5909
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-07-03
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TXM01042085R0203X
NM2002-01592085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10003314OtherLOVELACE
202014819OtherPRESBYTERIAN HEALTH PLANS
QMP000003379890OtherMOLINA
TX201277501Medicaid
2041478OtherUHC
NM98453271Medicaid
NMNM002L05OtherBCBS NM
2041478OtherUHC
TX345720101Medicare PIN
NMNM002L05OtherBCBS NM