Healthcare Provider Details

I. General information

NPI: 1477917086
Provider Name (Legal Business Name): SOOJEONG HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 NE 41ST ST CEDAR APARTMENTS E305
SEATTLE WA
98105-6373
US

IV. Provider business mailing address

1128 NE 41ST ST CEDAR APARTMENTS E305
SEATTLE WA
98105-6373
US

V. Phone/Fax

Practice location:
  • Phone: 646-647-0356
  • Fax:
Mailing address:
  • Phone: 646-647-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307599
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60660601
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60660601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: