Provider Demographics
NPI:1073880241
Name:HAN, HAI GU (LAC)
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:GU
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32387 YUCAIPA BLVD, STE F
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-7953
Mailing Address - Country:US
Mailing Address - Phone:909-797-9020
Mailing Address - Fax:909-363-0101
Practice Address - Street 1:32387 YUCAIPA BLVD STE A
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-1886
Practice Address - Country:US
Practice Address - Phone:909-797-9020
Practice Address - Fax:909-363-0101
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073880241OtherACUPUNCTURE