Provider Demographics
NPI:1184698250
Name:HAN, JIHYUK (MD)
Entity type:Individual
Prefix:DR
First Name:JIHYUK
Middle Name:
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 1:301 MANCHESTER ROAD
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2587
Mailing Address - Country:US
Mailing Address - Phone:845-485-5000
Mailing Address - Fax:845-485-5002
Practice Address - Street 1:301 MANCHESTER ROAD
Practice Address - Street 2:SUITE 203A
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2587
Practice Address - Country:US
Practice Address - Phone:845-485-5000
Practice Address - Fax:845-485-5002
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2265392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02535986Medicaid
NY02535986Medicaid
NY342BA1Medicare ID - Type Unspecified