Provider Demographics
NPI:1083954671
Name:HAN, KYOUNG MIN (DPM)
Entity Type:Individual
Prefix:
First Name:KYOUNG
Middle Name:MIN
Last Name:HAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15706 POMERADO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2032
Mailing Address - Country:US
Mailing Address - Phone:858-485-1494
Mailing Address - Fax:
Practice Address - Street 1:15706 POMERADO RD STE 102
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2032
Practice Address - Country:US
Practice Address - Phone:858-485-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5043213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery