Healthcare Provider Details

I. General information

NPI: 1164049904
Provider Name (Legal Business Name): HANNA KI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BEACH BLVD STE 111
ANAHEIM CA
92804-1866
US

IV. Provider business mailing address

408 S BEACH BLVD STE 111
ANAHEIM CA
92804-1866
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-8800
  • Fax:
Mailing address:
  • Phone: 714-826-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95023995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95097816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: