Healthcare Provider Details

I. General information

NPI: 1073056560
Provider Name (Legal Business Name): SOOAH HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 21
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7951
  • Fax: 212-263-0462
Mailing address:
  • Phone: 646-501-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341305
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: