Provider Demographics
NPI:1811288418
Name:NHAN, LISA (DPM)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:NHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:HOA
Other - Middle Name:
Other - Last Name:NHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 WEST COAST HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-491-9991
Mailing Address - Fax:949-258-5858
Practice Address - Street 1:3300 W COAST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4026
Practice Address - Country:US
Practice Address - Phone:949-491-9991
Practice Address - Fax:949-258-5858
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5121213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery