Provider Demographics
NPI:1114496403
Name:HAN, EDDIE S (HIS)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:S
Last Name:HAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E BASTANCHURY RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2782
Mailing Address - Country:US
Mailing Address - Phone:714-672-9445
Mailing Address - Fax:
Practice Address - Street 1:1020 E BASTANCHURY RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2782
Practice Address - Country:US
Practice Address - Phone:714-672-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH8040237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist