Healthcare Provider Details

I. General information

NPI: 1740201615
Provider Name (Legal Business Name): KWANGHOON HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

PO BOX 50095 SUITE 502
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-6285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD60665841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: