Provider Demographics
NPI:1093800112
Name:GENE S HAN, M.D., INC.
Entity Type:Organization
Organization Name:GENE S HAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-731-2020
Mailing Address - Street 1:3224 W OLYMPIC BLVD
Mailing Address - Street 2:#203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2317
Mailing Address - Country:US
Mailing Address - Phone:323-731-2020
Mailing Address - Fax:323-731-2134
Practice Address - Street 1:3224 W OLYMPIC BLVD
Practice Address - Street 2:#203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2317
Practice Address - Country:US
Practice Address - Phone:323-731-2020
Practice Address - Fax:323-731-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66800207N00000X
CAG61197207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13339Medicare PIN