Provider Demographics
NPI:1669663159
Name:HAN, JIANMING (MD)
Entity Type:Individual
Prefix:DR
First Name:JIANMING
Middle Name:
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 1:140 FOX RD
Mailing Address - Street 2:STE 201
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2475
Mailing Address - Country:US
Mailing Address - Phone:419-232-2077
Mailing Address - Fax:419-232-4498
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:STE 201
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-232-2077
Practice Address - Fax:419-232-4498
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2973493Medicaid
OH4258411Medicare PIN