Healthcare Provider Details

I. General information

NPI: 1386343192
Provider Name (Legal Business Name): HAN SAM CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17332 VON KARMAN AVE STE 110
IRVINE CA
92614-6280
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 12
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-3156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE BENJAMIN
Title or Position: CEO
Credential:
Phone: 949-783-7009