Provider Demographics
NPI:1447302997
Name:NAN, HAIJIN (PH D)
Entity type:Individual
Prefix:DR
First Name:HAIJIN
Middle Name:
Last Name:NAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S MANHATTAN PL
Mailing Address - Street 2:1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3621
Mailing Address - Country:US
Mailing Address - Phone:323-737-5989
Mailing Address - Fax:
Practice Address - Street 1:1220 S MANHATTAN PL
Practice Address - Street 2:1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3621
Practice Address - Country:US
Practice Address - Phone:323-737-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9227171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist