Provider Demographics
NPI:1780654616
Name:HAN, ERIN SUK-KYUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:SUK-KYUNG
Last Name:HAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 WILSHIRE BLVD
Mailing Address - Street 2:#104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3718
Mailing Address - Country:US
Mailing Address - Phone:213-369-4857
Mailing Address - Fax:
Practice Address - Street 1:3359 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1803
Practice Address - Country:US
Practice Address - Phone:213-382-2777
Practice Address - Fax:213-382-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8482T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0084820Medicaid
CAU20087Medicare UPIN
CASD0084820Medicaid