Provider Demographics
NPI:1801897335
Name:TONTHAT, HAN (MD)
Entity type:Individual
Prefix:DR
First Name:HAN
Middle Name:
Last Name:TONTHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 STERLING RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3838
Mailing Address - Country:US
Mailing Address - Phone:703-840-0610
Mailing Address - Fax:571-323-3243
Practice Address - Street 1:1035 STERLING RD STE 104
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3838
Practice Address - Country:US
Practice Address - Phone:703-840-0610
Practice Address - Fax:571-323-3243
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH11566Medicare UPIN
VA130889Medicare PIN