Provider Demographics
NPI:1699108399
Name:HAN, MICHAEL B (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BORAM
Other - Middle Name:CHARLES
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5258 BEACH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621
Mailing Address - Country:US
Mailing Address - Phone:714-523-2828
Mailing Address - Fax:509-664-4585
Practice Address - Street 1:5258 BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-523-2828
Practice Address - Fax:509-664-4585
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0397281223G0001X
CA1020831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice