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General NPI Number Information
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NPI Number | 1053005603
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Entity Type | Individual
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Provider Name | HAE JIN HAN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 950 UNSER BLVD SE STE 100
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City | RIO RANCHO
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State | NM
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Zip | 87124-6376
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Country | US
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Telephone | 505-892-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 950 UNSER BLVD SE STE 100
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City | RIO RANCHO
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State | NM
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Zip | 87124-6376
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Country | US
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Telephone | 505-892-2900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DB-2025-0502
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License Number State | NM
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