Provider Demographics
NPI:1689661225
Name:HANSEN, KEVIN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:HANSEN
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 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-782-1217
Mailing Address - Fax:916-782-7630
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-782-1217
Practice Address - Fax:916-782-7630
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist