Provider Demographics
NPI:1477545721
Name:HAN, WENCHIANG (MD)
Entity Type:Individual
Prefix:DR
First Name:WENCHIANG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 G ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5663
Mailing Address - Country:US
Mailing Address - Phone:530-749-8801
Mailing Address - Fax:530-749-8809
Practice Address - Street 1:414 G ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5663
Practice Address - Country:US
Practice Address - Phone:530-749-8801
Practice Address - Fax:530-749-8809
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730660Medicaid
CA81-0571721OtherTAX ID #
CA00A730660Medicaid
CA81-0571721OtherTAX ID #