Healthcare Provider Details

I. General information

NPI: 1902630288
Provider Name (Legal Business Name): HANNAH SHIRLEY KIM HURD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24331 EL TORO RD STE 200
LAGUNA WOODS CA
92637-3116
US

IV. Provider business mailing address

4565 ROYAL OAK RD
SANTA MARIA CA
93455-4347
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-3200
  • Fax:
Mailing address:
  • Phone: 805-868-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: