Provider Demographics
NPI:1659487866
Name:HAN, JAE HEE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HEE
Last Name:HAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N LIMA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1854
Mailing Address - Country:US
Mailing Address - Phone:818-319-8538
Mailing Address - Fax:
Practice Address - Street 1:20929 VENTURA BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2334
Practice Address - Country:US
Practice Address - Phone:818-883-4303
Practice Address - Fax:818-883-5331
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007090152W00000X
CA13415 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist