Provider Demographics
NPI:1609811686
Name:HANSON, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:155 N LAKE AVE
Mailing Address - Street 2:STE 800
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1857
Mailing Address - Country:US
Mailing Address - Phone:714-892-2333
Mailing Address - Fax:714-892-3979
Practice Address - Street 1:155 N LAKE AVE
Practice Address - Street 2:STE 800
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1857
Practice Address - Country:US
Practice Address - Phone:818-395-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45493208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF53673Medicare UPIN
CAWA45493IMedicare ID - Type UnspecifiedNHIC MEDICARE