Provider Demographics
NPI:1982659082
Name:HANSA, SAHAPHUN (MD)
Entity Type:Individual
Prefix:
First Name:SAHAPHUN
Middle Name:
Last Name:HANSA
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 1:3838 SAN DIMAS ST
Mailing Address - Street 2:SUITE A250
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2284
Mailing Address - Country:US
Mailing Address - Phone:661-323-5300
Mailing Address - Fax:661-323-5455
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:SUITE A250
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-323-5300
Practice Address - Fax:661-323-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70534207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
123665900OtherUS DEPARTMENT OF LABOR
CADC0466OtherRAILROAD MEDICARE
CA7296536Medicaid
CADC0466OtherRAILROAD MEDICARE
CA7296536Medicaid