Basic Information
| Provider Information | |||||||||
| NPI: | 1457855611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAN | ||||||||
| FirstName: | SUNG | ||||||||
| MiddleName: | YEUP | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172342561 | ||||||||
| FaxNumber: | 7172361121 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172342561 | ||||||||
| FaxNumber: | 7172361121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA059707 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | MA059707 | 01 | PA | PENNSYLVANIA LICENSE | OTHER |