Provider Demographics
NPI:1538352471
Name:HAN, DAVID SEUNG (MS, DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SEUNG
Last Name:HAN
Suffix:
Gender:M
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6040
Mailing Address - Country:US
Mailing Address - Phone:760-726-4790
Mailing Address - Fax:
Practice Address - Street 1:122 CIVIC CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6040
Practice Address - Country:US
Practice Address - Phone:760-726-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics