Basic Information
| Provider Information | |||||||||
| NPI: | 1851055396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANNAH KERN M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5506 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902315506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602575750 | ||||||||
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| Practice Location | |||||||||
| Address1: | 354 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606336507 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | KERN | ||||||||
| AuthorizedOfficialFirstName: | HANNAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8334436287 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 4794986 | 01 | CA | ARTICLES OF INCORPOERATION | OTHER |