Provider Demographics
NPI:1396846705
Name:SANG K. HAN, M.D., F.A.C.S., P.A.
Entity Type:Organization
Organization Name:SANG K. HAN, M.D., F.A.C.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-766-3331
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21123-0219
Mailing Address - Country:US
Mailing Address - Phone:410-766-3331
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE # 406
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-766-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCF8660OtherRAILROAD MEDICARE GROUP #
MDK967SAOtherCAREFIRST MARYLAND #
MDE388OtherBLUECHOICE #
MD548851600Medicaid
MDK967Medicare PIN
MD548851600Medicaid