Provider Demographics
NPI:1518016468
Name:DONG, HAN
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:
Last Name:DONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11754 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2460
Mailing Address - Country:US
Mailing Address - Phone:512-258-0488
Mailing Address - Fax:
Practice Address - Street 1:11754 JOLLYVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2460
Practice Address - Country:US
Practice Address - Phone:512-258-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00511171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist