Provider Demographics
NPI:1275693228
Name:HAN, GRACE S (DMD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:S
Last Name:HAN
Suffix:
Gender:F
Credentials:DMD
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 50223
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0223
Mailing Address - Country:US
Mailing Address - Phone:949-502-6406
Mailing Address - Fax:949-502-6407
Practice Address - Street 1:14785 JEFFREY RD
Practice Address - Street 2:STE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0408
Practice Address - Country:US
Practice Address - Phone:949-502-6406
Practice Address - Fax:949-502-6407
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice