Provider Demographics
NPI:1154514859
Name:HAN, JOSHUA SANG (CRNP-F)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:SANG
Last Name:HAN
Suffix:
Gender:M
Credentials:CRNP-F
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:SANG HO
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-787-8315
Mailing Address - Fax:410-787-8316
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 310
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-787-8315
Practice Address - Fax:410-787-8316
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC003201M72Medicare UPIN
MD082NS143Medicare UPIN