# JERRY A. HANSON, M.D. A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215137963
- **Authorized official:** DR. JERRY ALAN HANSON M.D. (PRESIDENT)
- **Authorized official phone:** (048) 295-2257

## Contact information

- **Practice address:** 2030 FOREST AVE, STE. 210, SAN JOSE, CA 95128-4833
- **Practice address phone:** (408) 295-2257
- **Practice address fax:** (408) 295-2264
- **Mailing address:** 2030 FOREST AVE, STE. 210, SAN JOSE, CA 95128-4833
- **Mailing address phone:** (408) 295-2257
- **Mailing address fax:** (408) 295-2264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | C33389 | CA | Yes |

## Other

- **Enumeration date:** 07/20/2007
- **Last updated:** 11/14/2007