Provider Demographics
NPI:1164027504
Name:HAN, REBECCA (MD, LAC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:MD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WEST 95TH STREET
Mailing Address - Street 2:LL6
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-422-7600
Mailing Address - Fax:
Practice Address - Street 1:4700 WEST 95TH STREET
Practice Address - Street 2:LL6
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-422-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.001408OtherIL STATE LICENSE PROVIDER NUMBER