Provider Demographics
NPI:1518424738
Name:HAN, JU HEUN
Entity Type:Individual
Prefix:
First Name:JU HEUN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JU HEUN
Other - Middle Name:
Other - Last Name:KI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3823 COLINA DORADA DR APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2843
Mailing Address - Country:US
Mailing Address - Phone:925-596-4609
Mailing Address - Fax:
Practice Address - Street 1:3110 CAMINO DEL RIO S STE 313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3832
Practice Address - Country:US
Practice Address - Phone:619-508-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist