Healthcare Provider Details

I. General information

NPI: 1487953840
Provider Name (Legal Business Name): KEVIN D HAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E VIRGINIA AVE STE 100
PHOENIX AZ
85004
US

IV. Provider business mailing address

370 E VIRGINIA AVE STE 100
PHOENIX AZ
85004-1254
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-4788
  • Fax:
Mailing address:
  • Phone: 602-258-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number55646
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number55646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: