Healthcare Provider Details

I. General information

NPI: 1205968104
Provider Name (Legal Business Name): GENE CHY YUAN HAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 HUNTINGTON AVE
SOUTH SAN FRANCISCO CA
94080-5990
US

IV. Provider business mailing address

1070 MARINA VILLAGE PKWY
ALAMEDA CA
94501-1076
US

V. Phone/Fax

Practice location:
  • Phone: 650-246-3829
  • Fax: 650-246-3838
Mailing address:
  • Phone: 510-747-0527
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number678116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: