Healthcare Provider Details

I. General information

NPI: 1235949678
Provider Name (Legal Business Name): SEYOUNG HAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14589 GEORGE CARTER WAY
CHANTILLY VA
20151-1881
US

IV. Provider business mailing address

14589 GEORGE CARTER WAY
CHANTILLY VA
20151-1881
US

V. Phone/Fax

Practice location:
  • Phone: 571-344-3158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011565
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0110011565
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: