Healthcare Provider Details

I. General information

NPI: 1457297434
Provider Name (Legal Business Name): SANG JIN HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11092 ANDERSON ST
LOMA LINDA CA
92350-1706
US

IV. Provider business mailing address

4705 WRIGHTSBORO RD
GROVETOWN GA
30813-3162
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4222
  • Fax:
Mailing address:
  • Phone: 909-558-4222
  • 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: