Provider Demographics
NPI:1972659860
Name:TIN, HAN (DDS)
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:
Last Name:TIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4017
Mailing Address - Country:US
Mailing Address - Phone:415-334-2584
Mailing Address - Fax:415-334-2584
Practice Address - Street 1:5865 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-4017
Practice Address - Country:US
Practice Address - Phone:415-334-2584
Practice Address - Fax:415-334-2584
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-92567-01Medicaid