Provider Demographics
NPI:1881856383
Name:HAN, JUNG SUN (DDS)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:SUN
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 1:170 KING ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1917
Mailing Address - Country:US
Mailing Address - Phone:415-347-3817
Mailing Address - Fax:
Practice Address - Street 1:170 KING ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1917
Practice Address - Country:US
Practice Address - Phone:415-347-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4951223P0300X
CA601061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics