MEDICARE: HANA DENTAL NY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	048768	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104830918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANA DENTAL NY P.C.

Provider Business Mailing Address
First Line	:	7523 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2305
Country	:	US
Telephone Number	:	718-238-4133
Fax Number	:	718-238-9843

Provider Business Practice Location Address
First Line	:	7523 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2305
Country	:	US
Telephone Number	:	718-238-4133
Fax Number	:	718-238-9843

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HAN JONG KANG
Credential	:	D.D.S.
Telephone Number	:	718-238-4133

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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