Healthcare Provider Details

I. General information

NPI: 1184256158
Provider Name (Legal Business Name): CRYSTAL HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/09/2026
Certification Date: 03/13/2022
Deactivation Date: 02/03/2026
Reactivation Date: 02/09/2026

III. Provider practice location address

6160 MISSION GORGE RD STE 100
SAN DIEGO CA
92120-3425
US

IV. Provider business mailing address

4440 TWAIN AVE APT 584
SAN DIEGO CA
92120-3573
US

V. Phone/Fax

Practice location:
  • Phone: 619-481-3790
  • Fax:
Mailing address:
  • Phone: 626-404-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: