Provider Demographics
NPI:1962737650
Name:HAN, STACIE YOUNG (ND, LAC)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:YOUNG
Last Name:HAN
Suffix:
Gender:
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL STE 408
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2815
Mailing Address - Country:US
Mailing Address - Phone:858-598-3858
Mailing Address - Fax:800-783-5451
Practice Address - Street 1:317 N EL CAMINO REAL STE 408
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2815
Practice Address - Country:US
Practice Address - Phone:858-598-3858
Practice Address - Fax:800-783-5451
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001273171100000X
CAWL3952171100000X
WANT60116083175F00000X
CAND1337175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist