Provider Demographics
NPI:1174652630
Name:HAN, SANG WOO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:SANG WOO
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 INWOOD TER
Mailing Address - Street 2:#4
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1775
Mailing Address - Country:US
Mailing Address - Phone:201-820-5581
Mailing Address - Fax:
Practice Address - Street 1:1297 INWOOD TER
Practice Address - Street 2:#4
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1775
Practice Address - Country:US
Practice Address - Phone:201-820-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00092400171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00092400OtherLICENSED ACUPUNCTURIST
NJ25MZ00092400OtherLICENSED ACUPUNCTURIST