Provider Demographics
NPI:1033663836
Name:HAN, CAROLINE (LAC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PARMA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1657
Mailing Address - Country:US
Mailing Address - Phone:714-308-7110
Mailing Address - Fax:
Practice Address - Street 1:22 PARMA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1657
Practice Address - Country:US
Practice Address - Phone:714-308-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist