Provider Demographics
NPI:1376232546
Name:HANNA, ARKAN I
Entity Type:Individual
Prefix:
First Name:ARKAN
Middle Name:
Last Name:HANNA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4107
Mailing Address - Country:US
Mailing Address - Phone:619-212-3978
Mailing Address - Fax:
Practice Address - Street 1:12515 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-4107
Practice Address - Country:US
Practice Address - Phone:619-212-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347C00000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle