MEDICARE: KENNY E. HANNA JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0105X	Surgery of the Hand (Surgery) Physician	14660	NV
2	2086S0105X	Surgery of the Hand (Surgery) Physician	C15029	CA

General Provider Information

NPI Number	:	1629283510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY E. HANNA JR. MD

Provider Business Mailing Address
First Line	:	8545 W WARM SPRINGS RD STE A4-343
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3676
Country	:	US
Telephone Number	:
Fax Number	:	702-933-8671

Provider Business Practice Location Address
First Line	:	319 S BRAND BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1701
Country	:	US
Telephone Number	:	818-240-0006
Fax Number	:	818-240-0038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/23/2019

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