Healthcare Provider Details

I. General information

NPI: 1881202224
Provider Name (Legal Business Name): JAMIE HAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TEAGARDEN ST
SAN LEANDRO CA
94577-4340
US

IV. Provider business mailing address

1465 65TH ST APT 251
EMERYVILLE CA
94608-1035
US

V. Phone/Fax

Practice location:
  • Phone: 510-667-6234
  • Fax:
Mailing address:
  • Phone: 650-722-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14828
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: