Healthcare Provider Details

I. General information

NPI: 1255194957
Provider Name (Legal Business Name): KATHRYN JEAN HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 220
WASHINGTON DC
20003-4338
US

IV. Provider business mailing address

1701 KALORAMA RD NW APT 206
WASHINGTON DC
20009-3507
US

V. Phone/Fax

Practice location:
  • Phone: 202-849-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2001664
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: