Healthcare Provider Details

I. General information

NPI: 1609811686
Provider Name (Legal Business Name): THOMAS HANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N LAKE AVE STE 800
PASADENA CA
91101-1857
US

IV. Provider business mailing address

155 N LAKE AVE STE 800
PASADENA CA
91101-1857
US

V. Phone/Fax

Practice location:
  • Phone: 818-395-8561
  • Fax:
Mailing address:
  • Phone: 714-892-2333
  • Fax: 714-892-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA45493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: