Healthcare Provider Details

I. General information

NPI: 1144897349
Provider Name (Legal Business Name): HANNAH STANG SU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH STANG GERDES MD

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 SAN PABLO AVE
SAN PABLO CA
94806-3818
US

IV. Provider business mailing address

13601 SAN PABLO AVE
SAN PABLO CA
94806-3818
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-9400
  • Fax: 925-957-5401
Mailing address:
  • Phone: 510-231-9400
  • Fax: 925-957-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: