1477607109 NPI number — CHRISTIAN TAE HO HAN M.P.T.

Table of content: CHRISTIAN TAE HO HAN M.P.T. (NPI 1477607109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477607109 NPI number — CHRISTIAN TAE HO HAN M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAN
Provider First Name:
CHRISTIAN
Provider Middle Name:
TAE HO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477607109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8492 BALTIMORE NATIONAL PIKE
Provider Second Line Business Mailing Address:
STE 207
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-3378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-776-0421
Provider Business Mailing Address Fax Number:
301-598-7432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3836 INTERNATIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20906-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-598-7420
Provider Business Practice Location Address Fax Number:
301-598-7432
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  20173 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 338063 . This is a "MAMSI LIFE MD IPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 683203200 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LK24AT . This is a "CF BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S9860005 . This is a "CF BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4039165 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com