Provider Demographics
NPI:1831882893
Name:HAN, JEE YOUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:JEE YOUNG
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 1:14628 NW WENDY LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9262
Mailing Address - Country:US
Mailing Address - Phone:608-770-5587
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR STE 260
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8652
Practice Address - Country:US
Practice Address - Phone:503-684-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD118491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice