Provider Demographics
NPI:1790720175
Name:HAESSLEIN, HANNS C (MD)
Entity Type:Individual
Prefix:DR
First Name:HANNS
Middle Name:C
Last Name:HAESSLEIN
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 1:459 WYNDGATE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5936
Mailing Address - Country:US
Mailing Address - Phone:916-485-3816
Mailing Address - Fax:916-483-3811
Practice Address - Street 1:1792 TRIBUTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4305
Practice Address - Country:US
Practice Address - Phone:916-678-5400
Practice Address - Fax:916-678-7666
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21049207VM0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41153Medicare UPIN
CA00G21049Medicare PIN