Healthcare Provider Details

I. General information

NPI: 1538307970
Provider Name (Legal Business Name): HANH D CLINE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SONOMA STREET
REDDING CA
96001
US

IV. Provider business mailing address

2420 SONOMA STREET
REDDING CA
96001
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-8908
  • Fax: 530-229-1148
Mailing address:
  • Phone: 530-225-8908
  • Fax: 530-229-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: