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General NPI Number Information
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NPI Number | 1861050502
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Entity Type | Organization
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Legal Business Name | HAN SAM CORP
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 300 SIERRA COLLEGE DR STE 250
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5083
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Country | US
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Telephone | 530-777-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 16782 VON KARMAN AVE STE 12
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City | IRVINE
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State | CA
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Zip | 92606-2417
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Country | US
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Telephone | 949-783-7012
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Fax | 949-743-8361
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Authorized Official
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Title or Position | OWNER
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Name | HANY SAMUEL BENJAMIN
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Credential |
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Telephone | 760-340-3248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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