Healthcare Provider Details

I. General information

NPI: 1962902478
Provider Name (Legal Business Name): SUNG HYON HAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON ST
NORWALK CT
06854-2704
US

IV. Provider business mailing address

25 N LEXINGTON AVE APT 1212
WHITE PLAINS NY
10601-1760
US

V. Phone/Fax

Practice location:
  • Phone: 917-744-7129
  • Fax:
Mailing address:
  • Phone: 917-744-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13795
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number063245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: