Provider Demographics
NPI:1598090573
Name:HAN, KELLY ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:HAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 N BROADWAY
Mailing Address - Street 2:SUITE #255
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3852
Mailing Address - Country:US
Mailing Address - Phone:503-407-0256
Mailing Address - Fax:
Practice Address - Street 1:1981 N BROADWAY
Practice Address - Street 2:SUITE #255
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3852
Practice Address - Country:US
Practice Address - Phone:503-407-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1691175F00000X
CAND-527175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath