=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518035914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K HANNANI, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 09/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 S SUNSET AVE STE 209
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-939-5900
-----------------------------------------------------
Fax | 626-939-0211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 S SUNSET AVE STE 209
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-939-5900
-----------------------------------------------------
Fax | 626-939-0211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KAMBIZ HANNANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-939-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | A061933
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------