Provider Demographics
NPI:1972649366
Name:HAN, SUNG
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 LAKE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8458
Mailing Address - Country:US
Mailing Address - Phone:901-230-1823
Mailing Address - Fax:770-441-0299
Practice Address - Street 1:1590 OAKBROOK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2245
Practice Address - Country:US
Practice Address - Phone:678-836-2221
Practice Address - Fax:770-441-0299
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice