Provider Demographics
NPI:1831381664
Name:WILLIAM I. HAN, M.D. INC
Entity type:Organization
Organization Name:WILLIAM I. HAN, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-444-3030
Mailing Address - Street 1:17150 EUCLID AVE.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4055
Mailing Address - Country:US
Mailing Address - Phone:714-444-3030
Mailing Address - Fax:949-419-2515
Practice Address - Street 1:17150 EUCLID ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-444-3030
Practice Address - Fax:714-444-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38218261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A382180Medicaid
A38218Medicare PIN
CA00A382180Medicaid