Basic Information
| Provider Information | |||||||||
| NPI: | 1598235764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAN | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | NGOC | ||||||||
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| OtherLastName: | HOANG | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | NGOC | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10790 RANCHO BERNARDO RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921275705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584871800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10862 CALLE VERDE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919417340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585547439 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2018 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95010488 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.