Provider Demographics
NPI:1255853412
Name:HAN, KYOUNG SOO (DDS)
Entity Type:Individual
Prefix:
First Name:KYOUNG SOO
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 BRISTOL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7880
Mailing Address - Country:US
Mailing Address - Phone:347-334-3564
Mailing Address - Fax:
Practice Address - Street 1:1595 GLIDEWELL DR STE 104
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8254
Practice Address - Country:US
Practice Address - Phone:336-524-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice