Basic Information
| Provider Information | |||||||||
| NPI: | 1578095956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | AVITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3151 N VILLERE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701176650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654067151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3940 DUPONT CIR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028951111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 55003 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.