Provider Demographics
NPI:1649211616
Name:HAN, MYUNG H (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:H
Last Name:HAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OAKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3016
Mailing Address - Country:US
Mailing Address - Phone:516-633-6449
Mailing Address - Fax:
Practice Address - Street 1:5925 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5547
Practice Address - Country:US
Practice Address - Phone:718-670-6100
Practice Address - Fax:718-670-6110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109649207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC67032Medicare UPIN
NY72760Medicare ID - Type Unspecified