Provider Demographics
NPI:1912063546
Name:HAN, JOHNNY STEVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:STEVE
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 E IMPERIAL HWY
Mailing Address - Street 2:SUITE #B
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6125
Mailing Address - Country:US
Mailing Address - Phone:714-529-8497
Mailing Address - Fax:714-529-8499
Practice Address - Street 1:2445 E IMPERIAL HWY
Practice Address - Street 2:SUITE #B
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6125
Practice Address - Country:US
Practice Address - Phone:714-529-8497
Practice Address - Fax:714-529-8499
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice