Provider Demographics
NPI:1093992778
Name:HAN, HEE-SUN (LAC)
Entity Type:Individual
Prefix:
First Name:HEE-SUN
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 1:10902 RIVERSIDE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2210
Mailing Address - Country:US
Mailing Address - Phone:310-488-0211
Mailing Address - Fax:
Practice Address - Street 1:10902 RIVERSIDE DR
Practice Address - Street 2:SUITE B
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2210
Practice Address - Country:US
Practice Address - Phone:310-488-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist