Provider Demographics
NPI:1275781932
Name:HAN, JANG, SON & SUH, DENTAL GROUP, PC
Entity Type:Organization
Organization Name:HAN, JANG, SON & SUH, DENTAL GROUP, PC
Other - Org Name:WILSHIRE PARK DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SEC./ EXEC. DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-380-7900
Mailing Address - Street 1:3700 WILSHIRE BLVD
Mailing Address - Street 2:780
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2901
Mailing Address - Country:US
Mailing Address - Phone:213-380-7900
Mailing Address - Fax:213-382-3454
Practice Address - Street 1:3700 WILSHIRE BLVD
Practice Address - Street 2:780
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2901
Practice Address - Country:US
Practice Address - Phone:213-380-7900
Practice Address - Fax:213-382-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty