Provider Demographics
NPI:1912901877
Name:HAN, MIN-KYU (MD)
Entity type:Individual
Prefix:DR
First Name:MIN-KYU
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 1:8921 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-2400
Mailing Address - Fax:309-243-5692
Practice Address - Street 1:8921 N WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-2400
Practice Address - Fax:309-243-5692
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127783207W00000X, 207W00000X
SD5433207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H62371Medicare UPIN
IAI12875Medicare PIN
NE10024952400Medicaid
SD6300680Medicaid
H62371Medicare UPIN
NE46044447400Medicaid
SD102367Medicare PIN
IA0581413Medicaid
IAIB1010004Medicare PIN
IA1581413Medicaid
MN839673600Medicaid
SDS42095Medicare PIN