Provider Demographics
NPI:1861649790
Name:HAN, THEO MYINT (DDS)
Entity Type:Individual
Prefix:
First Name:THEO
Middle Name:MYINT
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1910
Mailing Address - Country:US
Mailing Address - Phone:626-288-6622
Mailing Address - Fax:
Practice Address - Street 1:635 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-1910
Practice Address - Country:US
Practice Address - Phone:626-288-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD57320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist