Healthcare Provider Details

I. General information

NPI: 1497530828
Provider Name (Legal Business Name): JI IN HAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 POLLASKY AVE STE D
CLOVIS CA
93612-1159
US

IV. Provider business mailing address

5137 LAKEWOOD DR
VISALIA CA
93291-9016
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax: 559-751-0029
Mailing address:
  • Phone: 805-406-4915
  • Fax: 559-751-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: