Healthcare Provider Details

I. General information

NPI: 1427028927
Provider Name (Legal Business Name): TONY S HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR STE 3-3
SAN DIEGO CA
92134-2161
US

IV. Provider business mailing address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7621
  • Fax: 619-532-7625
Mailing address:
  • Phone: 619-532-5990
  • Fax: 619-532-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberHI10940
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG133252
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG133252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: