Provider Demographics
NPI:1902828874
Name:DAVID S. HAN, M.S., D.M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID S. HAN, M.S., D.M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DMD
Authorized Official - Phone:760-726-4790
Mailing Address - Street 1:122 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6040
Mailing Address - Country:US
Mailing Address - Phone:760-726-4790
Mailing Address - Fax:760-726-0960
Practice Address - Street 1:122 CIVIC CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6040
Practice Address - Country:US
Practice Address - Phone:760-726-4790
Practice Address - Fax:760-726-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty