Healthcare Provider Details

I. General information

NPI: 1639692601
Provider Name (Legal Business Name): CHIAKU HANSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE VISTA DEL MAR
LOS ANGELES CA
90034
US

IV. Provider business mailing address

3200 MOTOR AVE VISTA DEL MAR
LOS ANGELES CA
90034
US

V. Phone/Fax

Practice location:
  • Phone: 323-866-0555
  • Fax:
Mailing address:
  • Phone: 323-866-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: