MEDICARE: DR. JIN SOO HAN D.D.S.

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	1223G0001X	General Practice Dentistry	35726	CA

General Provider Information

NPI Number	:	1801996970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIN SOO HAN D.D.S.

Provider Business Mailing Address
First Line	:	6331 HAVEN AVE
Second Line	:	SUITE 17
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-6941
Country	:	US
Telephone Number	:	909-945-2002
Fax Number	:	909-945-2488

Provider Business Practice Location Address
First Line	:	6331 HAVEN AVE
Second Line	:	SUITE 17
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-6941
Country	:	US
Telephone Number	:	909-945-2002
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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