Provider Demographics
NPI:1134528755
Name:HAN, KENNY D (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:D
Last Name:HAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 OCEAN LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2543
Mailing Address - Country:US
Mailing Address - Phone:626-588-8368
Mailing Address - Fax:
Practice Address - Street 1:10635 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4828
Practice Address - Country:US
Practice Address - Phone:916-364-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist