Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019030666 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | DE60367270 | WA |
NPI | 1326338948 |
---|---|
Provider Name | Michael David Han |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2011 |
Last Update Date | 03/05/2017 |