MEDICARE: DAVID S. HAN, DDS, INC.

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	1223G0001X	General Practice Dentistry	39270	CA

General Provider Information

NPI Number	:	1881822278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID S. HAN, DDS, INC.

Provider Business Mailing Address
First Line	:	4200 CHINO HILLS PKWY
Second Line	:	STE-355
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3776
Country	:	US
Telephone Number	:	909-597-1770
Fax Number	:	909-393-5710

Provider Business Practice Location Address
First Line	:	4200 CHINO HILLS PKWY
Second Line	:	STE-355
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3776
Country	:	US
Telephone Number	:	909-597-1770
Fax Number	:	909-393-5710

Authorized Official
Title or Position	:	CEO
Name	:	DR. DAVID S HAN
Credential	:	DDS
Telephone Number	:	909-597-1770

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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