Provider Demographics
NPI:1063063774
Name:HAN, KYOUNG WON (DDS)
Entity type:Individual
Prefix:
First Name:KYOUNG WON
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4578 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2907
Mailing Address - Country:US
Mailing Address - Phone:609-751-7686
Mailing Address - Fax:
Practice Address - Street 1:43000 MIDWAY AVE BLDG 595
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5692
Practice Address - Country:US
Practice Address - Phone:619-524-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist