Healthcare Provider Details

I. General information

NPI: 1649811969
Provider Name (Legal Business Name): JIHEE HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 GERARD AVE
BRONX NY
10451-5239
US

IV. Provider business mailing address

595 GERARD AVE
BRONX NY
10451-5239
US

V. Phone/Fax

Practice location:
  • Phone: 929-348-4599
  • Fax:
Mailing address:
  • Phone: 929-348-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number558874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: