Provider Demographics
NPI:1841220258
Name:HAHN, ALBERT ICKSUN (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:ICKSUN
Last Name:HAHN
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 1:1 GOLDEN SHR
Mailing Address - Street 2:MOLINA MEDICAL CENTERS SMO
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4202
Mailing Address - Country:US
Mailing Address - Phone:562-491-7085
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:540 E ARTESIA BLVD
Practice Address - Street 2:MOLINA MEDICAL CENTERS
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1476
Practice Address - Country:US
Practice Address - Phone:562-491-7085
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A623540OtherMEDI CAL
CA00A623540OtherMEDI CAL