Provider Demographics
NPI:1558994632
Name:HANSEN, WAYNE JULIAN
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:JULIAN
Last Name:HANSEN
Suffix:
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 1:1816 S FIGUEROA ST FL 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3422
Mailing Address - Country:US
Mailing Address - Phone:213-763-0300
Mailing Address - Fax:
Practice Address - Street 1:1816 S FIGUEROA ST FL 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3422
Practice Address - Country:US
Practice Address - Phone:213-763-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker