Provider Demographics
NPI:1518269398
Name:HAN, CHANG YOUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHANG YOUN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AVALON DR
Mailing Address - Street 2:4134
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8584
Mailing Address - Country:US
Mailing Address - Phone:646-593-1146
Mailing Address - Fax:
Practice Address - Street 1:555 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4101
Practice Address - Country:US
Practice Address - Phone:413-736-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555941223G0001X
CT104031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice