Provider Demographics
NPI:1316396336
Name:HAN, KATHY DAO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:DAO
Last Name:HAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:OANHTUYET
Other - Middle Name:
Other - Last Name:DAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3555 WHIPPLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1507
Mailing Address - Country:US
Mailing Address - Phone:510-675-3030
Mailing Address - Fax:
Practice Address - Street 1:3555 WHIPPLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1507
Practice Address - Country:US
Practice Address - Phone:510-675-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant