Provider Demographics
NPI:1245766435
Name:HAN, MINYOUNG (L,AC)
Entity Type:Individual
Prefix:
First Name:MINYOUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:L,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32387 YUCAIPA BLVD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1885
Mailing Address - Country:US
Mailing Address - Phone:909-797-9020
Mailing Address - Fax:
Practice Address - Street 1:32387 YUCAIPA BLVD STE A
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-1886
Practice Address - Country:US
Practice Address - Phone:909-797-9020
Practice Address - Fax:909-363-0101
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073880241OtherACUPUNCTURE