Provider Demographics
NPI:1265249833
Name:HAN, CHRISTINE KYONGCHU
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:KYONGCHU
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250B INWOOD TER
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1739
Mailing Address - Country:US
Mailing Address - Phone:201-707-0532
Mailing Address - Fax:
Practice Address - Street 1:1250B INWOOD TER
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1739
Practice Address - Country:US
Practice Address - Phone:201-707-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007512-01171100000X
NJ25MZ00174300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist