MEDICARE: ALBERT ICKSUN HAHN 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	207Q00000X	Family Medicine Physician	A62354	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A623540	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1841220258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT ICKSUN HAHN MD

Provider Business Mailing Address
First Line	:	1 GOLDEN SHR
Second Line	:	MOLINA MEDICAL CENTERS SMO
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4202
Country	:	US
Telephone Number	:	562-491-7085
Fax Number	:	562-499-6171

Provider Business Practice Location Address
First Line	:	540 E ARTESIA BLVD
Second Line	:	MOLINA MEDICAL CENTERS
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1476
Country	:	US
Telephone Number	:	562-491-7085
Fax Number	:	562-499-6171

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

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

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