Provider Demographics
NPI:1760791180
Name:HAN, DONG Y (PSYD)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:Y
Last Name:HAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:L445
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5661
Mailing Address - Fax:859-323-5943
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:L445
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5661
Practice Address - Fax:859-323-5943
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2010-51103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist