Healthcare Provider Details

I. General information

NPI: 1023782943
Provider Name (Legal Business Name): HANNA PAIN RELIEF CLINICS PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16831 ALGONQUIN ST
HUNTINGTON BEACH CA
92649
US

IV. Provider business mailing address

2054 S HACIENDA BLVD UNIT 5233
HACIENDA HEIGHTS CA
91745-7610
US

V. Phone/Fax

Practice location:
  • Phone: 909-862-8888
  • Fax:
Mailing address:
  • Phone: 909-308-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNY E HANNA
Title or Position: OWNER
Credential: MD
Phone: 909-862-8888