Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | IN |
NPI | 1033107776 |
---|---|
Provider Name | Sangho Han |
First Address | Merrillville, IN 46410-6382 |
Second Address | Hammond, IN 46320-1931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D94906 | (02) | IN |