MEDICARE: DAVID S. HAN, M.S., D.M.D., A PROFESSIONAL CORPORATION

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	48607	CA

General Provider Information

NPI Number	:	1902828874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S. HAN, M.S., D.M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	122 CIVIC CENTER DR
Second Line	:	SUITE 104
City	:	VISTA
State	:	CA
Zip	:	92084-6040
Country	:	US
Telephone Number	:	760-726-4790
Fax Number	:	760-726-0960

Provider Business Practice Location Address
First Line	:	122 CIVIC CENTER DR
Second Line	:	SUITE 104
City	:	VISTA
State	:	CA
Zip	:	92084-6040
Country	:	US
Telephone Number	:	760-726-4790
Fax Number	:	760-726-0960

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DAVID S. HAN
Credential	:	M.S., D.M.D.
Telephone Number	:	760-726-4790

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/17/2016

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