Healthcare Provider Details

I. General information

NPI: 1861307704
Provider Name (Legal Business Name): JONG JIN HAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL HAN DDS

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

1922 W OGDEN AVE UNIT 1803
CHICAGO IL
60612-5587
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number018.002321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: