Provider Demographics
NPI:1649436205
Name:HAN, JI SOO (MD)
Entity type:Individual
Prefix:
First Name:JI SOO
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINCOLN HWY
Mailing Address - Street 2:SUITE 311A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-603-2122
Mailing Address - Fax:732-603-3566
Practice Address - Street 1:2 LINCOLN HWY
Practice Address - Street 2:SUITE 311A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-603-2122
Practice Address - Fax:732-603-3566
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08435100207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics