Provider Demographics
NPI:1942912597
Name:HAN, CHANHO J (DC)
Entity Type:Individual
Prefix:
First Name:CHANHO
Middle Name:J
Last Name:HAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22403 57TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2056
Mailing Address - Country:US
Mailing Address - Phone:516-567-7722
Mailing Address - Fax:
Practice Address - Street 1:42 BROADWAY STE 1535
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3885
Practice Address - Country:US
Practice Address - Phone:917-694-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013676-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor