Provider Demographics
NPI:1881986081
Name:HAN, JONG S (OMD, PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:JONG
Middle Name:S
Last Name:HAN
Suffix:
Gender:M
Credentials:OMD, PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1312
Mailing Address - Country:US
Mailing Address - Phone:650-364-2828
Mailing Address - Fax:650-364-2830
Practice Address - Street 1:720 WARREN ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1312
Practice Address - Country:US
Practice Address - Phone:650-364-2828
Practice Address - Fax:650-364-2830
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist