Provider Demographics
NPI:1841469640
Name:HAN, EDGAR HSE-HWA (DO)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:HSE-HWA
Last Name:HAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1521 N CARPENTER RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1147
Mailing Address - Country:US
Mailing Address - Phone:209-575-7520
Mailing Address - Fax:209-575-7515
Practice Address - Street 1:1521 N CARPENTER RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1147
Practice Address - Country:US
Practice Address - Phone:209-575-7520
Practice Address - Fax:209-575-7515
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9586208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation