Healthcare Provider Details

I. General information

NPI: 1649775719
Provider Name (Legal Business Name): HANNAH OBASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/27/2025
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1200 N STATE ST CTA7D
LOS ANGELES CA
90089-1001
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA165789
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA165789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: