Provider Demographics
NPI:1427059674
Name:LIEN, KHON HAN
Entity type:Individual
Prefix:DR
First Name:KHON
Middle Name:HAN
Last Name:LIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13703 RICHMOND PARK DR N
Mailing Address - Street 2:APT #3107
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1562 MITSCHER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-2421
Practice Address - Country:US
Practice Address - Phone:904-270-5602
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice