Provider Demographics
NPI:1184687337
Name:HANNA, KAREN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JEAN
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 1:2385 S. MELROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-300-3647
Mailing Address - Fax:760-482-1316
Practice Address - Street 1:2385 S. MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:760-300-3647
Practice Address - Fax:760-482-1316
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88851208600000X, 208D00000X
WAMD00044306208600000X
MO2007010595208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204463103Medicaid
MOP00408427Medicare PIN
MO311131108Medicare PIN
MO204463103Medicaid