MEDICARE: HAN S OHM L.AC., O.M.D.

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	171100000X	Acupuncturist	AC5068	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0993728	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1922179183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN S OHM L.AC., O.M.D.

Provider Business Mailing Address
First Line	:	3036 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2909
Country	:	US
Telephone Number	:	408-615-7560
Fax Number	:

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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