Provider Demographics
NPI:1932467024
Name:HAN, HONG (LAC)
Entity Type:Individual
Prefix:MS
First Name:HONG
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 1:25435 TRABUCO RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2786
Mailing Address - Country:US
Mailing Address - Phone:949-583-2881
Mailing Address - Fax:949-583-2881
Practice Address - Street 1:25435 TRABUCO RD STE 8
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2786
Practice Address - Country:US
Practice Address - Phone:949-583-2881
Practice Address - Fax:949-583-2881
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14870171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist