Provider Demographics
NPI:1639569064
Name:HAN, IRENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 S RAINBOW BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3134
Mailing Address - Country:US
Mailing Address - Phone:702-456-4600
Mailing Address - Fax:702-456-3600
Practice Address - Street 1:4250 S RAINBOW BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3134
Practice Address - Country:US
Practice Address - Phone:702-456-4600
Practice Address - Fax:702-456-3600
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65301223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice