Provider Demographics
NPI:1740497247
Name:HAN, SUE (RDH, BS)
Entity type:Individual
Prefix:MISS
First Name:SUE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S NORMANDIE AVE APT 427
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2293
Mailing Address - Country:US
Mailing Address - Phone:213-364-7373
Mailing Address - Fax:
Practice Address - Street 1:130 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2238
Practice Address - Country:US
Practice Address - Phone:213-484-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 19868124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist