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NPI Code Detail

MEDICARE: MISS SUE HAN RDH, BS

MEDICARE: MISS SUE HAN RDH, BS
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
1124Q00000XDental HygienistRDH 19868CA

General Provider Information

NPI Number : 1740497247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SUE HAN RDH, BS
Provider Business Mailing Address
First Line : 715 S NORMANDIE AVE APT 427
Second Line :
City : LOS ANGELES
State : CA
Zip : 90005-2293
Country : US
Telephone Number : 213-364-7373
Fax Number :
Provider Business Practice Location Address
First Line : 130 S ALVARADO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2238
Country : US
Telephone Number : 213-484-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 07/08/2007

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