Individual
BRENT HAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1036 N ARIZONA AVE, CHANDLER, AZ 85225-6600
(480) 618-0027
(520) 300-8059
Mailing address
PO BOX 746093, ATLANTA, GA 30374-6093
(888) 702-0617
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
011028
AZ
207Q00000X
Family Medicine Physician
20A15879
CA
207Q00000X
Family Medicine Physician
DO02543
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629451315
—
NV
01
—
V73854
MEDICARE
NV
Enumeration date
06/30/2015
Last updated
09/04/2024
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