Provider Demographics
NPI:1437169893
Name:ZACKSON, HANNAH JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:JUDITH
Last Name:ZACKSON
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 1:260 S CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3802
Mailing Address - Country:US
Mailing Address - Phone:310-553-9497
Mailing Address - Fax:310-553-9499
Practice Address - Street 1:260 S CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3802
Practice Address - Country:US
Practice Address - Phone:310-553-9497
Practice Address - Fax:310-553-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67710207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG67710BMedicare ID - Type Unspecified
CAE73021Medicare UPIN