Provider Demographics
NPI:1699360685
Name:HAN FAMILY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HAN FAMILY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-318-0810
Mailing Address - Street 1:11637 THE PLZ UNIT 45
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3930
Mailing Address - Country:US
Mailing Address - Phone:562-318-0810
Mailing Address - Fax:562-318-0811
Practice Address - Street 1:11637 THE PLZ UNIT 45
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3930
Practice Address - Country:US
Practice Address - Phone:562-318-0810
Practice Address - Fax:562-318-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A15879OtherOSTEOPATHIC MEDICINE