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Organization
PRIVATE MEDICAL GROUP
Active
Organization
PRIVATE MEDICAL GROUP
Active
Other names
Robert K. Hanson M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KEVIN HANSON M.D. (OWNER)
(818) 225-1617
Entity
Organization
Contact information
Practice address
22600 VENTURA BLVD., SUITE 104, WOODLAND HILLS, CA 91364-1458
(818) 225-1617
(818) 225-1620
Mailing address
22600 VENTURA BLVD., SUITE 104, WOODLAND HILLS, CA 91364-1458
(818) 225-1617
(818) 225-1620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G62711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G62711
STATE LICENSE
CA
01
—
ZZZ90227Z
OLD GROUP IDENTIFIER #
—
Enumeration date
04/18/2007
Last updated
08/22/2020
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