Healthcare Provider Details

I. General information

NPI: 1790580421
Provider Name (Legal Business Name): WON JUN HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 KINMAN AVE
GOLETA CA
93117-3481
US

IV. Provider business mailing address

6720 CALLE KORAL APT 104
GOLETA CA
93117-5364
US

V. Phone/Fax

Practice location:
  • Phone: 805-617-7900
  • Fax:
Mailing address:
  • Phone: 805-722-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: