Healthcare Provider Details

I. General information

NPI: 1740339852
Provider Name (Legal Business Name): HAN HADUONG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 TELEGRAPH RD
DOWNEY CA
90240-2426
US

IV. Provider business mailing address

9450 TELEGRAPH RD
DOWNEY CA
90240-2426
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-2157
  • Fax: 562-904-9588
Mailing address:
  • Phone: 562-904-2157
  • Fax: 562-904-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: