MEDICARE: SOPHIA FANG HANNA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY36258	CA
2	106H00000X	Marriage & Family Therapist	LMFT116293	CA

General Provider Information

NPI Number	:	1366919003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA FANG HANNA PSY.D.

Provider Business Mailing Address
First Line	:	4304 CHASE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6121
Country	:	US
Telephone Number	:	424-298-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 CHASE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6121
Country	:	US
Telephone Number	:	424-298-1209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	12/10/2025

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