Provider Demographics
NPI:1790319911
Name:HAN, JUNGYOUN (PHD, DNP)
Entity Type:Individual
Prefix:
First Name:JUNGYOUN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:PHD, DNP
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13724 ASH WAY UNIT E1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6389
Mailing Address - Country:US
Mailing Address - Phone:425-773-7492
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:425-773-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60341237163W00000X
WAAP61178901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse