Healthcare Provider Details

I. General information

NPI: 1659067312
Provider Name (Legal Business Name): JUSTIN Y HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YI HAN

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

IV. Provider business mailing address

603 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-4502
  • Fax: 541-426-6403
Mailing address:
  • Phone: 541-426-4502
  • Fax: 541-426-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD230434
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: