Healthcare Provider Details

I. General information

NPI: 1346863883
Provider Name (Legal Business Name): CHRISTOPHER DAVID HAHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PENNSYLVANIA ST
ORLANDO FL
32806-2937
US

IV. Provider business mailing address

86 W UNDERWOOD ST STE 202
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-3220
  • Fax: 321-843-3210
Mailing address:
  • Phone: 407-649-6876
  • Fax: 407-872-0544

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: