Provider Demographics
NPI:1497276265
Name:KIM, HAN NA (OD)
Entity Type:Individual
Prefix:
First Name:HAN NA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SILAS DEANE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4328
Mailing Address - Country:US
Mailing Address - Phone:860-329-1394
Mailing Address - Fax:
Practice Address - Street 1:1206 SILAS DEANE HWY STE 2
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4328
Practice Address - Country:US
Practice Address - Phone:860-329-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008646152W00000X
CT3037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist