Healthcare Provider Details

I. General information

NPI: 1003305814
Provider Name (Legal Business Name): JOANNE HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W MIDWAY DR
ANAHEIM CA
92805-6507
US

IV. Provider business mailing address

92 CORPORATE PARK STE C761
IRVINE CA
92606-5146
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-7107
  • Fax:
Mailing address:
  • Phone: 949-244-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: