Provider Demographics
NPI:1730769357
Name:HAN, ANTHONY DONG
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DONG
Last Name:HAN
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9162
Mailing Address - Country:US
Mailing Address - Phone:214-648-5617
Mailing Address - Fax:214-648-3289
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9162
Practice Address - Country:US
Practice Address - Phone:214-648-5617
Practice Address - Fax:214-648-3289
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1730769357207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program