Provider Demographics
NPI:1871685420
Name:HAN, CATHERINE JUNGHYE (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JUNGHYE
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 1:19733 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4143
Mailing Address - Country:US
Mailing Address - Phone:818-832-4646
Mailing Address - Fax:818-368-9898
Practice Address - Street 1:19733 RINALDI ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4143
Practice Address - Country:US
Practice Address - Phone:818-832-4646
Practice Address - Fax:818-368-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11143T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0111430Medicaid
CAU85933Medicare UPIN
CAOP11143Medicare ID - Type Unspecified