Healthcare Provider Details

I. General information

NPI: 1023540325
Provider Name (Legal Business Name): JOOYOUNG HAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 DEL AMO BLVD STE 102
LAKEWOOD CA
90712-2761
US

IV. Provider business mailing address

5445 DEL AMO BLVD STE 102
LAKEWOOD CA
90712-2761
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-0811
  • Fax: 562-866-4046
Mailing address:
  • Phone: 562-867-0811
  • Fax: 562-866-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: