=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720018575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JING K HAN O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 05/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2690 E BIDWELL ST STE#500
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-6430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-6838
-----------------------------------------------------
Fax | 916-983-6846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2690 E BIDWELL ST STE 500
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-6430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-6838
-----------------------------------------------------
Fax | 916-983-6846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12733
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------