MEDICARE: GENE SUK-JIN HAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G61197	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G611970	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144315797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE SUK-JIN HAN M.D.

Provider Business Mailing Address
First Line	:	3224 W OLYMPIC BLVD
Second Line	:	#203
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2317
Country	:	US
Telephone Number	:	323-731-2020
Fax Number	:	323-731-2134

Provider Business Practice Location Address
First Line	:	3224 W OLYMPIC BLVD
Second Line	:	#203
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2317
Country	:	US
Telephone Number	:	323-731-2020
Fax Number	:	323-731-2134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/24/2020

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