Provider Demographics
NPI:1710001359
Name:JI HAN, MD, PLLC
Entity type:Organization
Organization Name:JI HAN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JI
Authorized Official - Middle Name:HYEON
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-420-9845
Mailing Address - Street 1:435 E 70TH ST
Mailing Address - Street 2:APT 17J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5342
Mailing Address - Country:US
Mailing Address - Phone:347-420-9845
Mailing Address - Fax:
Practice Address - Street 1:3420 PARSONS BLVD
Practice Address - Street 2:SUITE LR-LS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4637
Practice Address - Country:US
Practice Address - Phone:347-420-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232226261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain