Healthcare Provider Details

I. General information

NPI: 1972649366
Provider Name (Legal Business Name): DR. SUNG HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 OAKBROOK DR SUITE 200
NORCROSS GA
30093-2245
US

IV. Provider business mailing address

1049 LAKE POINTE CT
SUWANEE GA
30024-8458
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2221
  • Fax: 770-441-0299
Mailing address:
  • Phone: 901-230-1823
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: