Provider Demographics
NPI:1942278312
Name:HANSON, MOLLY SIANG BOON (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SIANG BOON
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE., #270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:909-398-1573
Practice Address - Street 1:11965 CACTUS RD.
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-4906
Practice Address - Country:US
Practice Address - Phone:760-561-6081
Practice Address - Fax:877-778-9461
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A404060Medicaid
CAA29118Medicare ID - Type Unspecified
CA00A404060Medicaid
CAEW142ZMedicare PIN