Provider Demographics
NPI:1295701076
Name:HAN, JONATHAN KYUNG HO (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KYUNG HO
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 11TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 ELEVENTH ST STE C
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6179
Practice Address - Country:US
Practice Address - Phone:724-334-3640
Practice Address - Fax:724-334-3644
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064116L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001778220Medicaid
F44990Medicare UPIN
PA001778220Medicaid