Provider Demographics
NPI:1225579071
Name:HAN, SHANG HYEUN
Entity Type:Individual
Prefix:
First Name:SHANG HYEUN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 195TH ST
Mailing Address - Street 2:2FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4040 195TH ST
Practice Address - Street 2:2FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3024
Practice Address - Country:US
Practice Address - Phone:929-256-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse