Healthcare Provider Details

I. General information

NPI: 1043300114
Provider Name (Legal Business Name): WILLIAM I HAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 EUCLID ST STE 220
FOUNTAIN VALLEY CA
92708-4092
US

IV. Provider business mailing address

17150 EUCLID ST STE 220
FOUNTAIN VALLEY CA
92708-4092
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-3030
  • Fax: 949-419-2515
Mailing address:
  • Phone: 714-444-3030
  • Fax: 949-419-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA38218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: