Healthcare Provider Details

I. General information

NPI: 1841469640
Provider Name (Legal Business Name): EDGAR HSE-HWA HAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N CARPENTER RD SUITE D-1
MODESTO CA
95351-1147
US

IV. Provider business mailing address

1521 N CARPENTER RD SUITE D-1
MODESTO CA
95351-1147
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-7520
  • Fax: 209-575-7515
Mailing address:
  • Phone: 209-575-7520
  • Fax: 209-575-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A9586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: