Provider Demographics
NPI:1043749401
Name:HAN, SANG-KYOU (LAC, DIPL OM, PHD)
Entity Type:Individual
Prefix:
First Name:SANG-KYOU
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC, DIPL OM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 GABLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4905
Mailing Address - Country:US
Mailing Address - Phone:760-421-1321
Mailing Address - Fax:
Practice Address - Street 1:756 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2330
Practice Address - Country:US
Practice Address - Phone:760-421-1321
Practice Address - Fax:760-683-6903
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17562171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist