MEDICARE: ANNIE HAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	792169	CA
2	363LF0000X	Family Nurse Practitioner	95005370	CA

General Provider Information

NPI Number	:	1376085290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE HAN

Provider Business Mailing Address
First Line	:	463 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	629-522-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	463 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	629-522-0399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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Directions to “ ANNIE HAN ” Practice Location

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