Healthcare Provider Details

I. General information

NPI: 1629197702
Provider Name (Legal Business Name): JOSEPH ROBERT HAHN R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST SUITE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

500 N 9TH ST SUITE C
MODESTO CA
95350-5814
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4600
  • Fax: 209-558-4702
Mailing address:
  • Phone: 209-558-4420
  • Fax: 209-558-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number637879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: