Provider Demographics
NPI:1003954942
Name:HANNA, HANAA N (MD)
Entity Type:Individual
Prefix:DR
First Name:HANAA
Middle Name:N
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3603
Mailing Address - Country:US
Mailing Address - Phone:310-547-0887
Mailing Address - Fax:310-547-4296
Practice Address - Street 1:887 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3603
Practice Address - Country:US
Practice Address - Phone:310-547-0887
Practice Address - Fax:310-547-4296
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38447174400000X
CAA52577208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952337321Medicaid
CA1811342751OtherNPPES