Provider Demographics
NPI:1972207918
Name:HAN, RONALD (LAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SORENSON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1643
Mailing Address - Country:US
Mailing Address - Phone:714-326-9594
Mailing Address - Fax:
Practice Address - Street 1:3060 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6818
Practice Address - Country:US
Practice Address - Phone:714-326-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist