Jiwon Han, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

38712 Issued in TX

Practice address

12584 N Beach St Ste 150
Fort Worth, TX 76244-4250

Phone

(817) 337-0021

NPI assigned

Jul 22, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ideal Dental of Fort Worth, PLLC

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1437407392
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1144955170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12584 N BEACH ST STE 150",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12584 N BEACH ST STE 150",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444250",
            "telephone_number": "817-337-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAN",
        "first_name": "JIWON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "38712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Han Pham Hulen MD PA
• Han Pham Hulen, MD, P.a.
• Albert Han
• Derek Yang Han
• Jennifer Han, M.D.
• Juliette Catherine Han, FNP-C
• Vivian Tran Han, PHARM D
• Tamara K Hanby, DO
• Abbie Byrd Hancock, LCSW
• Kenneth Charles Hancock, M.D.

• Dentist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.