Provider Demographics
NPI:1134236276
Name:HAN, DONGYEON PETER (MD)
Entity type:Individual
Prefix:
First Name:DONGYEON
Middle Name:PETER
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 1:2900 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4802
Mailing Address - Country:US
Mailing Address - Phone:501-278-2800
Mailing Address - Fax:
Practice Address - Street 1:2900 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4802
Practice Address - Country:US
Practice Address - Phone:501-278-2800
Practice Address - Fax:501-278-8309
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046787208800000X
ARE-4160208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134236276Medicaid
VA1134236276OtherBCBS
AR155040001Medicaid
E18279Medicare UPIN
VA1134236276OtherBCBS
VA1134236276OtherBCBS