1609804020 NPI number — DR. HESUN HAN M.D.

Table of content: DR. HESUN HAN M.D. (NPI 1609804020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609804020 NPI number — DR. HESUN HAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAN
Provider First Name:
HESUN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1609804020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 WINN WAY
Provider Second Line Business Mailing Address:
SUITE A-210
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-294-7033
Provider Business Mailing Address Fax Number:
404-296-4661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 HURRICANE SHOALS RD NW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-645-7150
Provider Business Practice Location Address Fax Number:
770-339-4797
Provider Enumeration Date:
06/28/2006

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: 207RN0300X , with the licence number:  44929 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00809234A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44929 . This is a "LIC NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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