Provider Demographics
NPI:1992937569
Name:HAN, YUKYUNG (MS, RD/LD)
Entity type:Individual
Prefix:MS
First Name:YUKYUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 N WHISENANT DR
Mailing Address - Street 2:BOX 2000
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1650
Mailing Address - Country:US
Mailing Address - Phone:580-251-8881
Mailing Address - Fax:580-251-8892
Practice Address - Street 1:1407 N WHISENANT DR
Practice Address - Street 2:BOX 2000
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1650
Practice Address - Country:US
Practice Address - Phone:580-251-8881
Practice Address - Fax:580-251-8892
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered