Healthcare Provider Details

I. General information

NPI: 1467999250
Provider Name (Legal Business Name): JOHN C HAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN 103
REDLANDS CA
92374-0111
US

IV. Provider business mailing address

1895 ORANGE TREE LN 103
REDLANDS CA
92374-0111
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-4848
  • Fax: 909-435-0511
Mailing address:
  • Phone: 909-885-4848
  • Fax: 909-435-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number45263
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN C HAN
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 909-885-4848