Provider Demographics
NPI:1720018575
Name:HAN, JING K (OD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:K
Last Name:HAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2690 E BIDWELL ST
Mailing Address - Street 2:STE 500
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6430
Mailing Address - Country:US
Mailing Address - Phone:916-983-6838
Mailing Address - Fax:916-983-6846
Practice Address - Street 1:2690 E BIDWELL ST
Practice Address - Street 2:STE#500
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6430
Practice Address - Country:US
Practice Address - Phone:916-983-6838
Practice Address - Fax:916-983-6846
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08260Medicare UPIN