Provider Demographics
NPI:1497133383
Name:HAN, TIMOTHY BYEONGAN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BYEONGAN
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BYEONGAN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3068
Mailing Address - Country:US
Mailing Address - Phone:470-550-9101
Mailing Address - Fax:800-886-9976
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD STE J
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3068
Practice Address - Country:US
Practice Address - Phone:470-550-9101
Practice Address - Fax:800-886-9976
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15295171100000X
GA456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist