MEDICARE: DR. DAVID C HANSEN MD

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	174400000X	Specialist	G51164	CA

General Provider Information

NPI Number	:	1770552374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID C HANSEN MD

Provider Business Mailing Address
First Line	:	9201 W SUNSET BLVD
Second Line	:	612
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3701
Country	:	US
Telephone Number	:	310-273-8006
Fax Number	:	310-273-0974

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD
Second Line	:	612
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3701
Country	:	US
Telephone Number	:	310-273-8006
Fax Number	:	310-273-0974

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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