Provider Demographics
NPI:1962282400
Name:HAN, SEUNG JI (DDS)
Entity type:Individual
Prefix:DR
First Name:SEUNG JI
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLA
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:310 S JEFFERSON ST APT 11F
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5464
Mailing Address - Country:US
Mailing Address - Phone:248-909-5203
Mailing Address - Fax:
Practice Address - Street 1:310 S JEFFERSON ST APT 11F
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5464
Practice Address - Country:US
Practice Address - Phone:248-909-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice