Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.024500 | OH |
Y | 1223P0221X | Pediatric Dentist | 8892 | SC |
NPI | 1073993804 |
---|---|
Provider Name | Dr. Byungdo B Han |
First Address | Columbia, SC 29223-1725 |
Second Address | Columbia, SC 29223-1725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2015 |
Last Update Date | 14/05/2020 |