Provider Demographics
NPI:1902452162
Name:HAN, SAMUEL SANGHUN (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SANGHUN
Last Name:HAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SANGHUN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5978 IVY LEAGUE DR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5783
Mailing Address - Country:US
Mailing Address - Phone:443-823-6193
Mailing Address - Fax:
Practice Address - Street 1:1419 KNECHT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1415
Practice Address - Country:US
Practice Address - Phone:410-247-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist