Provider Demographics
NPI:1548600695
Name:HAN, PHIL (DMD)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 SW KING JAMES PL STE 20
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2481
Mailing Address - Country:US
Mailing Address - Phone:503-296-2901
Mailing Address - Fax:503-406-4988
Practice Address - Street 1:11820 SW KING JAMES PLACE SUITE 20
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-968-2901
Practice Address - Fax:503-406-4988
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD100461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice