Provider Demographics
NPI:1689729253
Name:HANJAN, TIVA (MD)
Entity Type:Individual
Prefix:
First Name:TIVA
Middle Name:
Last Name:HANJAN
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 1:26401 CROWN VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6302
Mailing Address - Country:US
Mailing Address - Phone:949-348-4000
Mailing Address - Fax:949-348-7466
Practice Address - Street 1:26401 CROWN VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6302
Practice Address - Country:US
Practice Address - Phone:949-348-4000
Practice Address - Fax:949-348-7466
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81862208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000263442OtherHMSA
CAAQ220YMedicare PIN
HI0000263442OtherHMSA
HII71037Medicare UPIN