Jesse T Han, D.D.S.
Individual provider Active NPI Oral & Maxillofacial Surgery (D.M.D.) · Piedmont, CA
NPI 1194185249 · NPPES record last updated Mar 26, 2024
Key facts
- NPI
- 1194185249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.) 204E00000X
- License
- 105648 (CA)
- Practice address
- 1057 Harvard Rd
Piedmont, CA 94610-1128 - Phone
- (925) 699-9981
- NPI assigned
- Mar 2, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240201001904 | CA | Order and Referring Only - Oral Surgery |
4789037144 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105648 | CA | MD | Oral & Maxillofacial Surgery (D.M.D.) |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 105648 | CA | Yes |
Addresses
Primary practice location
1057 Harvard Rd
Piedmont, CA 94610-1128
Mailing address
1959 NE Pacific St
Box 357134
Seattle, WA 98195-0001
Other providers in Piedmont, CA
- Megan Graham
- Amy Whalen Griffith
- Mary Jane Gross
- Christopher Guerisoli
- Chantal Guite
- Lillian Cora Hanson
- Christopher Hartford
- Shanni He
- Dale Brian Herrero
- Constance Colton Herrick
All providers in Piedmont, CA · Oral & Maxillofacial Surgery (D.M.D.) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.