Provider Demographics
NPI:1225655921
Name:HAN, JAE YOUNG (DDS, MBA)
Entity type:Individual
Prefix:DR
First Name:JAE YOUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 FIVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4214
Mailing Address - Country:US
Mailing Address - Phone:517-882-3600
Mailing Address - Fax:517-882-3511
Practice Address - Street 1:4315 FIVE OAKS DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4214
Practice Address - Country:US
Practice Address - Phone:517-882-3600
Practice Address - Fax:517-882-3511
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600513122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist