Healthcare Provider Details

I. General information

NPI: 1235434119
Provider Name (Legal Business Name): HANNA CHANG BIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12675 LA MIRADA BLVD STE 401
LA MIRADA CA
90638-2236
US

IV. Provider business mailing address

12675 LA MIRADA BLVD STE 401
LA MIRADA CA
90638-2236
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5435
  • Fax:
Mailing address:
  • Phone: 562-789-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number109633
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number826434
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC-109633
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: