Healthcare Provider Details

I. General information

NPI: 1427964154
Provider Name (Legal Business Name): HANA FAKHOURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PORTOLA RD
PORTOLA VALLEY CA
94028-7654
US

IV. Provider business mailing address

9521 KOSTNER AVE
SKOKIE IL
60076-1329
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-1501
  • Fax:
Mailing address:
  • Phone: 773-706-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040296
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: