Provider Demographics
NPI:1164049904
Name:KI, HANNA (RN)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:KI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16410 S DALTON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-6072
Mailing Address - Country:US
Mailing Address - Phone:310-896-6233
Mailing Address - Fax:
Practice Address - Street 1:720 ALAMITOS AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4726
Practice Address - Country:US
Practice Address - Phone:310-896-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95097816163W00000X
CA95023995363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse