Healthcare Provider Details

I. General information

NPI: 1295701076
Provider Name (Legal Business Name): JONATHAN KYUNG HO HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELEVENTH ST STE C
NEW KENSINGTON PA
15068-6179
US

IV. Provider business mailing address

301 11TH ST SUITE C
NEW KENSINGTON PA
15068
US

V. Phone/Fax

Practice location:
  • Phone: 724-334-3640
  • Fax: 724-334-3644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD064116L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: