Healthcare Provider Details

I. General information

NPI: 1114715364
Provider Name (Legal Business Name): DOROTHY HAN MD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

1016 METRO CIR
PALO ALTO CA
94303-3835
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5117
  • Fax:
Mailing address:
  • Phone:
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1114715364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: