Provider Demographics
NPI:1780569442
Name:HANSON, SAMMUEL RICHARD JI
Entity type:Individual
Prefix:
First Name:SAMMUEL
Middle Name:RICHARD JI
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAMM
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21830 W 119TH TER UNIT 1500
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST STE G400
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS14-119521183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program