Provider Demographics
NPI:1447213616
Name:HANSON, ROBERT KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEVIN
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1910
Mailing Address - Country:US
Mailing Address - Phone:818-225-1617
Mailing Address - Fax:818-225-1620
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-225-1617
Practice Address - Fax:818-225-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62711OtherSTATE LICENSE
CAE96530Medicare UPIN
CAE96530Medicare UPIN