Healthcare Provider Details

I. General information

NPI: 1982590816
Provider Name (Legal Business Name): JENNY HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 101
HARBOR CITY CA
90710-2084
US

IV. Provider business mailing address

2000 E CHAPMAN AVE STE 100
FULLERTON CA
92831-4103
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: