Provider Demographics
NPI:1962884247
Name:HAN, DONG WU (DMD)
Entity type:Individual
Prefix:
First Name:DONG WU
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 E 56TH AVE UNIT N104
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1611
Mailing Address - Country:US
Mailing Address - Phone:425-681-6653
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4278
Practice Address - Country:US
Practice Address - Phone:425-641-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist