Basic Information
| Provider Information | |||||||||
| NPI: | 1922118033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAN | ||||||||
| FirstName: | KYUNG | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172624660 | ||||||||
| FaxNumber: | 7172636251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 183949 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0204X | 183949 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | 25MA06934900 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0001X | MD469511 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 10487600 | 01 | CAQH | OTHER | 1000066816 | 01 | NY | AFFINITY HEALTH PLANS | OTHER | 1768750 | 01 | NY | AETNA HMO PROVIDER # | OTHER | 183949-NY | 01 | NY | 1199 HEALTH FUND PROVIDER # | OTHER | 321310 | 01 | NY | US FAMILY HEALTH PLAN | OTHER | 2686E1 | 01 | NY | EMPIRE BCBS (YONKERS) | OTHER | 5551677 | 01 | NY | AETNA PPO PROVIDER # | OTHER | 080506000082 | 01 | NY | FIDELIS CARE | OTHER | 01267918 | 05 | NY | MEDICAID |