Provider Demographics
NPI:1578038741
Name:HAN, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:KOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4595 WILSHIRE BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3829
Mailing Address - Country:US
Mailing Address - Phone:213-210-5981
Mailing Address - Fax:
Practice Address - Street 1:2207 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1302
Practice Address - Country:US
Practice Address - Phone:626-282-6954
Practice Address - Fax:626-282-0550
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist