Healthcare Provider Details

I. General information

NPI: 1194928770
Provider Name (Legal Business Name): JOSHUA DANIEL HANELIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 MCBEAN PKWY
VALENCIA CA
91355-4466
US

IV. Provider business mailing address

20 EXECUTIVE PARK STE 155
IRVINE CA
92614-4733
US

V. Phone/Fax

Practice location:
  • Phone: 323-549-3030
  • Fax: 323-549-3149
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMDR4995
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA115815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: