=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619619897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YESEO HAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2022
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 CORPORATE PLAZA DR
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-791-3101
-----------------------------------------------------
Fax | 949-791-3112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 CORPORATE PLAZA DR
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-557-0840
-----------------------------------------------------
Fax | 949-557-0841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A203243
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------