Provider Demographics
NPI:1366529349
Name:HAN, HONGSHIK (MD)
Entity type:Individual
Prefix:DR
First Name:HONGSHIK
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 N MAPLE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8009
Mailing Address - Country:US
Mailing Address - Phone:559-325-3832
Mailing Address - Fax:559-325-2603
Practice Address - Street 1:7005 N MAPLE AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8009
Practice Address - Country:US
Practice Address - Phone:559-325-3832
Practice Address - Fax:559-325-2603
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA851692082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14867Medicare UPIN
CAZZZ3003ZZMedicare ID - Type Unspecified