Provider Demographics
NPI:1750802195
Name:HAN, SUL KI (OD)
Entity type:Individual
Prefix:DR
First Name:SUL KI
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5253
Mailing Address - Country:US
Mailing Address - Phone:559-261-5063
Mailing Address - Fax:
Practice Address - Street 1:7339 EL CAJON BLVD STE JK
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-722-8460
Practice Address - Fax:619-722-8465
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9274T152W00000X, 152WC0802X
CA34171TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management