Provider Demographics
NPI:1356376172
Name:HAN, KEVIN (LAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9938 BOLSA AVE
Mailing Address - Street 2:#105
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6039
Mailing Address - Country:US
Mailing Address - Phone:714-775-1688
Mailing Address - Fax:714-775-1668
Practice Address - Street 1:9938 BOLSA AVE
Practice Address - Street 2:#105
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6039
Practice Address - Country:US
Practice Address - Phone:714-775-1688
Practice Address - Fax:714-775-1668
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0040900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0040900Medicaid