MEDICARE: FANFAN HAN

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	363LP2300X	Primary Care Nurse Practitioner	F355920-01	NY

General Provider Information

NPI Number	:	1982555280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FANFAN HAN

Provider Business Mailing Address
First Line	:	190 E 206TH ST APT 4E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13620 MAPLE AVE # C705
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-5166
Country	:	US
Telephone Number	:	917-679-4510
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “ FANFAN HAN ” Practice Location

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