Provider Demographics
NPI:1962902478
Name:HAN, SUNG HYON (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNG HYON
Middle Name:
Last Name:HAN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MIDLAND PL APT 2413
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-4249
Mailing Address - Country:US
Mailing Address - Phone:917-744-7129
Mailing Address - Fax:
Practice Address - Street 1:1110 STATE ROUTE 55 STE 107
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5048
Practice Address - Country:US
Practice Address - Phone:845-320-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT137951223S0112X
NY0632451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery