Provider Demographics
NPI:1356652549
Name:HAN, HYESUNG
Entity Type:Individual
Prefix:
First Name:HYESUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 GRASSLANDS DR
Mailing Address - Street 2:APT 2013
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3532
Mailing Address - Country:US
Mailing Address - Phone:857-540-2254
Mailing Address - Fax:
Practice Address - Street 1:5075 OLIVEHURST AVE
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961
Practice Address - Country:US
Practice Address - Phone:530-634-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist