MEDICARE: ISAAC IKSEUNG HAN DO

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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	207Q00000X	Family Medicine Physician	25MB11166400	NJ

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	:	1467954701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC IKSEUNG HAN DO

Provider Business Mailing Address
First Line	:	95 OLD SHORT HILLS RD
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-1008
Country	:	US
Telephone Number	:	888-724-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 HEDDEN TER
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-6109
Country	:	US
Telephone Number	:	201-991-5353
Fax Number	:	201-991-0587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2018
Last Update Date	:	03/18/2024

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Directions to “ ISAAC IKSEUNG HAN DO” Practice Location

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