Basic Information
Provider Information
NPI: 1508485103
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAN
FirstName: DAO-YU
MiddleName: DAVID
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 PARRISH ST APT 1
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191302382
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 160 E ERIE AVE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191341011
CountryCode: US
TelephoneNumber: 2154275000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/13/2020
LastUpdateDate: 03/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDS042641PAY Dental ProvidersDentist 

No ID Information.


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