Provider Demographics
NPI:1649957267
Name:HAN, BOYOUNG (DMD)
Entity type:Individual
Prefix:
First Name:BOYOUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ASHEVILLE RD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3681
Mailing Address - Country:US
Mailing Address - Phone:253-514-7840
Mailing Address - Fax:
Practice Address - Street 1:364 HARVARD ST # 1C
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2920
Practice Address - Country:US
Practice Address - Phone:617-232-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859836122300000X
RIDEN03668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist