Healthcare Provider Details

I. General information

NPI: 1063364040
Provider Name (Legal Business Name): KATYA ANI HANESSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W CHAPMAN AVE STE 7200
ORANGE CA
92868-1623
US

IV. Provider business mailing address

3800 W CHAPMAN AVE STE 72000
ORANGE CA
92868-1638
US

V. Phone/Fax

Practice location:
  • Phone: 888-268-1108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: