Provider Demographics
NPI:1821257817
Name:HAN, IRIS K (DDS)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:K
Last Name:HAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 MAYFIELD AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5730
Mailing Address - Country:US
Mailing Address - Phone:310-948-5220
Mailing Address - Fax:
Practice Address - Street 1:163 W VENTURA BLVD STE C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8375
Practice Address - Country:US
Practice Address - Phone:805-484-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053793-11223G0001X
CA57532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist