Healthcare Provider Details

I. General information

NPI: 1790319911
Provider Name (Legal Business Name): JUNGYOUN HAN PHD, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE HAN

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

13724 ASH WAY UNIT E1
EVERETT WA
98204-6389
US

V. Phone/Fax

Practice location:
  • Phone: 425-773-7492
  • Fax:
Mailing address:
  • Phone: 425-773-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61178901
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60341237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: