Healthcare Provider Details

I. General information

NPI: 1558194993
Provider Name (Legal Business Name): ANDREW HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31371 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1847
US

IV. Provider business mailing address

25761 MAPLE VIEW DR
LAGUNA HILLS CA
92653-7549
US

V. Phone/Fax

Practice location:
  • Phone: 949-429-2155
  • Fax:
Mailing address:
  • Phone: 949-614-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: