Provider Demographics
NPI:1023540325
Name:HAN, JOOYOUNG (DPM)
Entity Type:Individual
Prefix:
First Name:JOOYOUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DEL AMO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2761
Mailing Address - Country:US
Mailing Address - Phone:562-867-0811
Mailing Address - Fax:562-866-4046
Practice Address - Street 1:5445 DEL AMO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2761
Practice Address - Country:US
Practice Address - Phone:562-867-0811
Practice Address - Fax:562-866-4046
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5685213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist