Provider Demographics
NPI:1841493715
Name:HAKANSON, GLENN G (MD,)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:G
Last Name:HAKANSON
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 1:2300 N ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5757
Mailing Address - Country:US
Mailing Address - Phone:916-444-9231
Mailing Address - Fax:916-444-0476
Practice Address - Street 1:2300 N ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5757
Practice Address - Country:US
Practice Address - Phone:916-444-9231
Practice Address - Fax:916-444-0476
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG303712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44395Medicare UPIN