Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401413303 | VA |
N | 122300000X | Dentist | 14934 | MD |
N | 122300000X | Dentist | DS037297 | PA |
N | 1223P0300X | Periodontist | 0401413301 | VA |
N | 1223P0300X | Periodontist | 14934 | MD |
N | 1223P0300X | Periodontist | DS037297 | PA |
NPI | 1023314333 |
---|---|
Provider Name | Dr. Sok Woong Daniel Han |
First Address | Mc Lean, VA 22101-6007 |
Second Address | Mc Lean, VA 22101-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2011 |
Last Update Date | 19/06/2013 |