Healthcare Provider Details

I. General information

NPI: 1871685420
Provider Name (Legal Business Name): CATHERINE JUNGHYE HAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19733 RINALDI ST
PORTER RANCH CA
91326-4143
US

IV. Provider business mailing address

19733 RINALDI ST
PORTER RANCH CA
91326-4143
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-4646
  • Fax: 818-368-9898
Mailing address:
  • Phone: 818-832-4646
  • Fax: 818-368-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11143T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: