Provider Demographics
NPI:1861832149
Name:KYOUNG MIN HAN,DPM PC INC.,
Entity Type:Organization
Organization Name:KYOUNG MIN HAN,DPM PC INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:KYOUNG MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,
Authorized Official - Phone:562-868-0787
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90651-1292
Mailing Address - Country:US
Mailing Address - Phone:562-868-0787
Mailing Address - Fax:562-375-6188
Practice Address - Street 1:12820 STUDEBAKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2578
Practice Address - Country:US
Practice Address - Phone:562-868-0787
Practice Address - Fax:562-375-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5043213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty