Provider Demographics
NPI:1902170459
Name:HAN, MUN (DN)
Entity Type:Individual
Prefix:DR
First Name:MUN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2819
Mailing Address - Country:US
Mailing Address - Phone:773-993-0065
Mailing Address - Fax:773-993-0065
Practice Address - Street 1:4007 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2819
Practice Address - Country:US
Practice Address - Phone:773-993-0065
Practice Address - Fax:773-993-0065
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000375172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath