Basic Information
Provider Information
NPI: 1609170042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANNA
FirstName: KARIM
MiddleName: ANTHONY
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 210 N TUSTIN AVE
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927053807
CountryCode: US
TelephoneNumber: 7143471010
FaxNumber: 7146471245
Practice Location
Address1: 9920 TALBERT AVE
Address2:  
City: FOUNTAIN VALLEY
State: CA
PostalCode: 927085153
CountryCode: US
TelephoneNumber: 7143787000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/28/2010
LastUpdateDate: 07/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA117275CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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