Healthcare Provider Details

I. General information

NPI: 1235058223
Provider Name (Legal Business Name): JOON HAN DDS, MSMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 BROADWAY ST STE A7
AMERICAN CANYON CA
94503-1228
US

IV. Provider business mailing address

3431 BROADWAY ST STE A7
AMERICAN CANYON CA
94503-1228
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-5057
  • Fax:
Mailing address:
  • Phone: 707-557-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: