MEDICARE: HANJUN GUAN DMD PHD LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1366026155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANJUN GUAN DMD PHD LLC

Provider Business Mailing Address
First Line	:	2204 S TAYLOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3007
Country	:	US
Telephone Number	:	216-321-3462
Fax Number	:

Provider Business Practice Location Address
First Line	:	2204 S TAYLOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3007
Country	:	US
Telephone Number	:	216-321-3462
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HANJUN GUAN
Credential	:	DMD PHD
Telephone Number	:	859-361-4032

Provider Enumeration Date	:	05/08/2021
Last Update Date	:	05/08/2021

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