Provider Demographics
NPI:1881024115
Name:HAN, SOO HEE (LAC)
Entity Type:Individual
Prefix:
First Name:SOO HEE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2094
Mailing Address - Country:US
Mailing Address - Phone:714-522-1600
Mailing Address - Fax:714-522-1605
Practice Address - Street 1:5730 BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2094
Practice Address - Country:US
Practice Address - Phone:714-522-1600
Practice Address - Fax:714-522-1605
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15696171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist