Provider Demographics
NPI:1578930897
Name:HAN, JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 AVENUE OF THE AMERICAS
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10105-0302
Mailing Address - Country:US
Mailing Address - Phone:212-913-0828
Mailing Address - Fax:212-913-0633
Practice Address - Street 1:1345 AVENUE OF THE AMERICAS
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105-0302
Practice Address - Country:US
Practice Address - Phone:212-913-0828
Practice Address - Fax:212-913-0633
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09936363A00000X
NY020479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant