Healthcare Provider Details

I. General information

NPI: 1134633845
Provider Name (Legal Business Name): DAVID HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N EUCLID ST FL 5
ANAHEIM CA
92801-1900
US

IV. Provider business mailing address

1188 N EUCLID ST
ANAHEIM CA
92801-1900
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax:
Mailing address:
  • Phone: 714-644-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW77358
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW96434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: