Healthcare Provider Details

I. General information

NPI: 1962737650
Provider Name (Legal Business Name): STACIE YOUNG HAN ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 408
ENCINITAS CA
92024-2815
US

IV. Provider business mailing address

317 N EL CAMINO REAL STE 408
ENCINITAS CA
92024-2815
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-3858
  • Fax: 800-783-5451
Mailing address:
  • Phone: 858-598-3858
  • Fax: 800-783-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.001273
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberWL3952
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60116083
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: