Provider Demographics
NPI:1740306745
Name:HAN, KISOO (DC)
Entity type:Individual
Prefix:DR
First Name:KISOO
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 BROADWAY
Mailing Address - Street 2:STE 1A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2539
Mailing Address - Country:US
Mailing Address - Phone:415-563-3800
Mailing Address - Fax:415-292-7911
Practice Address - Street 1:1545 BROADWAY
Practice Address - Street 2:STE 1A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2539
Practice Address - Country:US
Practice Address - Phone:415-563-3800
Practice Address - Fax:415-292-7911
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04981Medicare UPIN
CADC0296140Medicare ID - Type Unspecified