Provider Demographics
NPI:1649330010
Name:HAN, MAN
Entity type:Individual
Prefix:PROF
First Name:MAN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2120 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3700
Mailing Address - Country:US
Mailing Address - Phone:916-771-6605
Mailing Address - Fax:916-771-7777
Practice Address - Street 1:2120 PROFESSIONAL DR
Practice Address - Street 2:SUITE 135
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3700
Practice Address - Country:US
Practice Address - Phone:916-771-6605
Practice Address - Fax:916-771-7777
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist