Provider Demographics
NPI:1265790901
Name:HAN, PAUL HYUNWOO (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HYUNWOO
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 POMERADO RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-673-2574
Mailing Address - Fax:858-207-0039
Practice Address - Street 1:211 13TH ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2711
Practice Address - Country:US
Practice Address - Phone:760-789-5160
Practice Address - Fax:760-788-7962
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281626207Q00000X
CAA138715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A138715OtherMD LICENSE