Individual
AENA D HAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1505 W 17TH ST STE 1, SAN BERNARDINO, CA 92411-1202
(909) 887-6494
(909) 887-6043
Mailing address
1855 W REDLANDS BLVD FL 2, REDLANDS, CA 92373-3145
(909) 890-0407
(909) 890-0575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
17791
MS
208000000X
Pediatrics Physician
Primary
52866
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01972509
—
MS
Enumeration date
02/06/2007
Last updated
03/10/2021
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