Provider Demographics
NPI:1912917576
Name:HAN, SUNG SOON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:SOON
Last Name:HAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUNG
Other - Middle Name:S
Other - Last Name:HAN-KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8394 GOVERNORS RUN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3448
Mailing Address - Country:US
Mailing Address - Phone:410-750-1119
Mailing Address - Fax:410-750-1119
Practice Address - Street 1:3355 ST JOHNS LN
Practice Address - Street 2:STE F
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-750-1119
Practice Address - Fax:410-750-1119
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
80030001Medicare ID - Type Unspecified