Provider Demographics
NPI:1174743603
Name:HAN, JOHN S
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
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 1:8706 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11832 ROSECRANS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4107
Practice Address - Country:US
Practice Address - Phone:213-216-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC62909B208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C429090Medicaid
CAAH1141566OtherDEA
CAD84532Medicare UPIN
CAC42909BMedicare ID - Type Unspecified