Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E5685 | CA |
Y | 222Z00000X | Podiatrist | E5685 | CA |
NPI | 1023540325 |
---|---|
Provider Name | Jooyoung Han |
First Address | Montclair, CA 91763-2213 |
Second Address | Montclair, CA 91763-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 29/07/2021 |