Provider Demographics
NPI:1952565244
Name:HAN, SUNG WON
Entity Type:Individual
Prefix:
First Name:SUNG WON
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 ELSINORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1356
Mailing Address - Country:US
Mailing Address - Phone:213-219-1758
Mailing Address - Fax:
Practice Address - Street 1:421 N BROOKHURST ST STE 218
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5619
Practice Address - Country:US
Practice Address - Phone:657-201-9444
Practice Address - Fax:747-300-0071
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC. 12401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist