Provider Demographics
NPI:1750440806
Name:HAN, PETER MYUNG
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MYUNG
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23715 RIDGECREST CT
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-6114
Mailing Address - Country:US
Mailing Address - Phone:909-612-0498
Mailing Address - Fax:
Practice Address - Street 1:1169 FAIRWAY DR STE 102
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91789-2847
Practice Address - Country:US
Practice Address - Phone:909-718-0244
Practice Address - Fax:909-718-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor