Healthcare Provider Details

I. General information

NPI: 1578662490
Provider Name (Legal Business Name): KASEMSANT HANSUVADHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAM K HANS M.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 W 7TH ST
OXNARD CA
93030-6755
US

IV. Provider business mailing address

2204 INDIAN WELLS CT.
OXNARD CA
93030-6755
US

V. Phone/Fax

Practice location:
  • Phone: 805-487-9897
  • Fax: 805-487-6667
Mailing address:
  • Phone: 805-983-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: