Basic Information
| Provider Information | |||||||||
| NPI: | 1194892331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAN | ||||||||
| FirstName: | KWANG | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8320 OLD COURTHOUSE RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105214 | ||||||||
| FaxNumber: | 7038105409 | ||||||||
| Practice Location | |||||||||
| Address1: | 8320 OLD COURTHOUSE RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105214 | ||||||||
| FaxNumber: | 7038105409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 11/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | DC871116 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305203449 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 184961 | 01 | VA | ANTHEM BCBS | OTHER | 716792 | 01 | VA | NCPPO | OTHER |