MEDICARE: DR. VAN A HAN DMD

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	122300000X	Dentist	D8959	OR

General Provider Information

NPI Number	:	1972703239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAN A HAN DMD

Provider Business Mailing Address
First Line	:	14201 NE 20TH AVE
Second Line	:	2204
City	:	VANCOUVER
State	:	WA
Zip	:	98686-6410
Country	:	US
Telephone Number	:	360-571-8181
Fax Number	:	360-573-4022

Provider Business Practice Location Address
First Line	:	3502 NE BROADWAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232
Country	:	US
Telephone Number	:	503-255-2710
Fax Number	:	503-255-9965

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	08/17/2009

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