Provider Demographics
NPI:1194892331
Name:HAN, KWANG S (MPT)
Entity type:Individual
Prefix:MR
First Name:KWANG
Middle Name:S
Last Name:HAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8320 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3831
Mailing Address - Country:US
Mailing Address - Phone:703-810-5214
Mailing Address - Fax:703-810-5409
Practice Address - Street 1:8320 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3831
Practice Address - Country:US
Practice Address - Phone:703-810-5214
Practice Address - Fax:703-810-5409
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC871116225100000X
VA2305203449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184961OtherANTHEM BCBS
VA716792OtherNCPPO