Provider Demographics
NPI:1205155785
Name:HAN, MOONGI (MAOM)
Entity type:Individual
Prefix:DR
First Name:MOONGI
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 40TH ST W APT 1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3801
Mailing Address - Country:US
Mailing Address - Phone:847-712-8125
Mailing Address - Fax:
Practice Address - Street 1:3816 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4552
Practice Address - Country:US
Practice Address - Phone:847-712-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60493370171100000X
IL198000925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198000925OtherSTATE LICENSE