Provider Demographics
NPI:1306392113
Name:HAN-IM, YANGSUN
Entity Type:Individual
Prefix:
First Name:YANGSUN
Middle Name:
Last Name:HAN-IM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 2ND AVENUE
Mailing Address - Street 2:MANIILAQ BHS
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752
Mailing Address - Country:US
Mailing Address - Phone:907-442-7612
Mailing Address - Fax:907-442-7749
Practice Address - Street 1:733 2ND AVENUE
Practice Address - Street 2:MANIILAQ BHS
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7612
Practice Address - Fax:907-442-7749
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator