Provider Demographics
NPI:1972506988
Name:HAN, PAUL Y (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:Y
Last Name:HAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8877
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8877
Mailing Address - Country:US
Mailing Address - Phone:714-850-1300
Mailing Address - Fax:714-850-1301
Practice Address - Street 1:2621 S BRISTOL ST
Practice Address - Street 2:STE 209
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5719
Practice Address - Country:US
Practice Address - Phone:714-850-1300
Practice Address - Fax:714-850-1301
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3270213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E32700OtherBLUE SHIELD
CA000E32700Medicaid
CAWE3270BMedicare PIN
CA000E32700OtherBLUE SHIELD
CA4985490001Medicare NSC
CAWE3270CMedicare PIN