Provider Demographics
NPI:1942206560
Name:HANNON, ZIYAD (MD)
Entity Type:Individual
Prefix:
First Name:ZIYAD
Middle Name:
Last Name:HANNON
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 1:2645 OCEAN AVE
Mailing Address - Street 2:STE 309
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:STE 309
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1647
Practice Address - Country:US
Practice Address - Phone:415-334-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C401870OtherBLUE SHIELD OF CALIFORNIA
CA00C401871Medicaid
CA00C401870OtherBLUE SHIELD OF CALIFORNIA
CA00C401870Medicare ID - Type Unspecified