Provider Demographics
NPI:1790947562
Name:HAN, JIN YONG (MD)
Entity Type:Individual
Prefix:
First Name:JIN YONG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 TAUB LOOP
Mailing Address - Street 2:NPC BUILDING 2ND FL
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-873-5130
Mailing Address - Fax:713-873-5148
Practice Address - Street 1:1502 TAUB LOOP
Practice Address - Street 2:NPC BUILDING 2ND FL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-5130
Practice Address - Fax:713-873-5148
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6341207Q00000X, 2084P0800X
NY2661302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130395Medicare PIN