Basic Information
| Provider Information | |||||||||
| NPI: | 1841220258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | ICKSUN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GOLDEN SHR | ||||||||
| Address2: | MOLINA MEDICAL CENTERS SMO | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908024202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624917085 | ||||||||
| FaxNumber: | 5624996171 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 E ARTESIA BLVD | ||||||||
| Address2: | MOLINA MEDICAL CENTERS | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908051476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624917085 | ||||||||
| FaxNumber: | 5624996171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A62354 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A623540 | 01 | CA | MEDI CAL | OTHER |