Healthcare Provider Details

I. General information

NPI: 1649192865
Provider Name (Legal Business Name): SHUANG HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 CARTER ST
FOLSOM CA
95630-9569
US

IV. Provider business mailing address

908 CARTER ST
FOLSOM CA
95630-9569
US

V. Phone/Fax

Practice location:
  • Phone: 443-857-2270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: