Healthcare Provider Details

I. General information

NPI: 1730874462
Provider Name (Legal Business Name): HAE RI HAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10670 WEXFORD ST
SAN DIEGO CA
92131-3940
US

IV. Provider business mailing address

10670 WEXFORD ST
SAN DIEGO CA
92131-3940
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHS000015
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: