Provider Demographics
NPI:1811333669
Name:HAN, HAESUN (PT)
Entity type:Individual
Prefix:
First Name:HAESUN
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ZINFANDEL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2862
Mailing Address - Country:US
Mailing Address - Phone:916-635-9199
Mailing Address - Fax:
Practice Address - Street 1:1995 ZINFANDEL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2862
Practice Address - Country:US
Practice Address - Phone:916-635-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 398842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic