Healthcare Provider Details

I. General information

NPI: 1659012367
Provider Name (Legal Business Name): SAMOUEL HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

V. Phone/Fax

Practice location:
  • Phone: 949-207-8167
  • Fax:
Mailing address:
  • Phone: 949-207-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA191079
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA191079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: