Provider Demographics
NPI:1588688758
Name:HAN, CHI SUN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHI SUN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1702
Mailing Address - Country:US
Mailing Address - Phone:201-768-0466
Mailing Address - Fax:201-768-1242
Practice Address - Street 1:144 PARIS AVE
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1702
Practice Address - Country:US
Practice Address - Phone:201-768-0466
Practice Address - Fax:201-768-1242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047504-11223G0001X
NJ22DI020353001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02740605Medicaid