Provider Demographics
NPI:1336141126
Name:HAN, TINA S (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:HAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOO
Other - Middle Name:KYONG
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:601 W GOLF RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4276
Practice Address - Country:US
Practice Address - Phone:847-439-8780
Practice Address - Fax:847-298-6395
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336073885207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109348Medicaid
IL1616108OtherBCBS
ILK19018Medicare PIN
ILI34316Medicare UPIN
IL1616108OtherBCBS
IL922820Medicare PIN
ILK19019Medicare ID - Type Unspecified
ILP00228946Medicare PIN
IL575480Medicare PIN