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General NPI Number Information
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NPI Number | 1629451315
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Entity Type | Individual
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Provider Name | BRENT HAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1036 N ARIZONA AVE
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City | CHANDLER
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State | AZ
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Zip | 85225-6600
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Country | US
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Telephone | 480-618-0027
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Fax | 520-300-8059
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Provider Business Mailing Address
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Address Line | PO BOX 746093
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City | ATLANTA
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State | GA
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Zip | 30374-6093
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Country | US
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Telephone | 888-702-0617
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Fax | 312-929-0373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A15879
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO02543
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 011028
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License Number State | AZ
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