Healthcare Provider Details

I. General information

NPI: 1316472608
Provider Name (Legal Business Name): STEPHANIE YOONJU HAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY PKWY W STE 200
ORANGE CA
92868-2941
US

IV. Provider business mailing address

500 CITY PKWY W STE 200
ORANGE CA
92868-2941
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6761
  • Fax:
Mailing address:
  • Phone: 714-480-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA158328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: