Active NPI
Christine Hyesook Han
- General Practice Dentistry
- Jurupa Valley, CA
National Provider Identifier
1740952043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 106793
- Practice address
- 4834 Etiwanda Ave Ste 200
Jurupa Valley, CA 91752-1828 - Phone
- (951) 688-7249
- NPI assigned
- Oct 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 106793 | CA | Primary |
Addresses
Primary practice location
4834 Etiwanda Ave Ste 200
Jurupa Valley, CA 91752-1828
Mailing address
25617 Prospect Ave
Loma Linda, CA 92354-3169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106793 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673740800000",
"number": "1740952043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25617 PROSPECT AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4834 ETIWANDA AVE STE 200",
"city": "JURUPA VALLEY",
"state": "CA",
"postal_code": "917521828",
"telephone_number": "951-688-7249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAN",
"first_name": "CHRISTINE",
"middle_name": "HYESOOK",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-05",
"last_updated": "2023-01-15",
"certification_date": "2023-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "106793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jurupa Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.