Provider Demographics
NPI:1528084878
Name:HAN, ABRAHAM P (MD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:P
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S AZUSA AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6854
Mailing Address - Country:US
Mailing Address - Phone:626-810-5998
Mailing Address - Fax:626-810-8973
Practice Address - Street 1:1850 S AZUSA AVE STE 309
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6854
Practice Address - Country:US
Practice Address - Phone:626-810-5998
Practice Address - Fax:626-810-8973
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G723780Medicaid
CAF38051Medicare UPIN
CA00G723780Medicaid