=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255516043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANFORD ORTHOPAEDICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 W. SEVENTH STREET
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-582-9621
-----------------------------------------------------
Fax | 559-582-9622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1329
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93232-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-582-9621
-----------------------------------------------------
Fax | 559-582-9622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KENNY T. MAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-582-9621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A96023
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------