Healthcare Provider Details

I. General information

NPI: 1194649194
Provider Name (Legal Business Name): JI HYUN HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 KUHL AVE FL 6
ORLANDO FL
32806-2024
US

IV. Provider business mailing address

1705 KUHL AVE FL 6
ORLANDO FL
32806-2024
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5437
  • Fax:
Mailing address:
  • Phone: 321-843-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: