Provider Demographics
NPI:1659417400
Name:HAN, BOKYUNG (DDS)
Entity Type:Individual
Prefix:
First Name:BOKYUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 BARRANCA PKWY
Mailing Address - Street 2:#303
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4671
Mailing Address - Country:US
Mailing Address - Phone:949-333-3334
Mailing Address - Fax:949-333-3335
Practice Address - Street 1:4950 BARRANCA PARKWAY
Practice Address - Street 2:#303
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-333-3334
Practice Address - Fax:949-333-3335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist