Healthcare Provider Details

I. General information

NPI: 1013175777
Provider Name (Legal Business Name): SEUNG HUN HAN L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 WASHINGTON AVE
WESTWOOD NJ
07675-2024
US

IV. Provider business mailing address

96 WASHINGTON AVE
WESTWOOD NJ
07675-2024
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-9200
  • Fax:
Mailing address:
  • Phone: 201-664-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00113300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: