Provider Demographics
NPI:1255879235
Name:HAN, SHANG (HA8163)
Entity type:Individual
Prefix:
First Name:SHANG
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:HA8163
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19637 VICTORY BLVD.
Mailing Address - Street 2:14
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6302
Mailing Address - Country:US
Mailing Address - Phone:818-343-8116
Mailing Address - Fax:
Practice Address - Street 1:19367 VICTORY BLVD
Practice Address - Street 2:14
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6302
Practice Address - Country:US
Practice Address - Phone:818-343-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8163237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist