Provider Demographics
NPI:1770851537
Name:HAN, YOUNG (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 US HIGHWAY 93 N
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2627
Mailing Address - Country:US
Mailing Address - Phone:406-752-1131
Mailing Address - Fax:
Practice Address - Street 1:1256 N MERIDIAN RD STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3006
Practice Address - Country:US
Practice Address - Phone:406-752-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics