Basic Information
Provider Information
NPI: 1801236567
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAN
FirstName: HANS
MiddleName: PO-AN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3181 SW SAM JACKSON PARK RD
Address2: OHSU
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034948220
FaxNumber:  
Practice Location
Address1: 3181 SW SAM JACKSON PARK RD
Address2: OHSU
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034948220
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2013
LastUpdateDate: 09/23/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD180113ORY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
MD18011301OROREGON MEDICAL BOARDOTHER


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