Healthcare Provider Details

I. General information

NPI: 1548224694
Provider Name (Legal Business Name): SCOTT L. HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE STE 509
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

1635 DIVISADERO STREET, SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2165
  • Fax: 415-353-4300
Mailing address:
  • Phone: 415-353-4217
  • Fax: 415-353-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA67958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: