Healthcare Provider Details

I. General information

NPI: 1265790901
Provider Name (Legal Business Name): PAUL HYUNWOO HAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 13TH ST
RAMONA CA
92065-2711
US

IV. Provider business mailing address

15611 POMERADO RD
POWAY CA
92064-2437
US

V. Phone/Fax

Practice location:
  • Phone: 760-789-5160
  • Fax: 760-788-7962
Mailing address:
  • Phone: 858-673-2574
  • Fax: 858-207-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number281626
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA138715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: