Provider Demographics
NPI:1568677714
Name:ABRAHAM P HAN A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ABRAHAM P HAN A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-810-5998
Mailing Address - Street 1:1850 S AZUSA AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6813
Mailing Address - Country:US
Mailing Address - Phone:626-810-5998
Mailing Address - Fax:626-810-8973
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-810-5998
Practice Address - Fax:626-810-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G723780Medicaid
CA00G723780OtherINSURANCE
CA00G723781Medicaid
CA00G723780OtherINSURANCE
CA00G723780Medicaid