Healthcare Provider Details

I. General information

NPI: 1255070629
Provider Name (Legal Business Name): JANE JINSOL HAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 SUNSET OFFICE DR STE C102
SAINT LOUIS MO
63127-1014
US

IV. Provider business mailing address

3555 SUNSET OFFICE DR STE C102
SAINT LOUIS MO
63127-1014
US

V. Phone/Fax

Practice location:
  • Phone: 314-934-3308
  • Fax:
Mailing address:
  • Phone: 314-934-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNA
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2026009543
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.080232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: