=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093800112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENE S HAN, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 03/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3224 W OLYMPIC BLVD #203
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-731-2020
-----------------------------------------------------
Fax | 323-731-2134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3224 W OLYMPIC BLVD #203
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-731-2020
-----------------------------------------------------
Fax | 323-731-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GENE S HAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-731-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | G66800
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | G61197
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------