Provider Demographics
NPI:1801937750
Name:HAN, JI H (MD)
Entity type:Individual
Prefix:DR
First Name:JI
Middle Name:H
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 1:18816 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2811
Mailing Address - Country:US
Mailing Address - Phone:718-762-7000
Mailing Address - Fax:718-762-7002
Practice Address - Street 1:18816 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2811
Practice Address - Country:US
Practice Address - Phone:718-762-7000
Practice Address - Fax:718-762-7002
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 232226208VP0014X
NY232226-1208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2892419Medicaid