1104161439 NPI number — DR. DAVID HAHN PSYCHOLOGIST PC

Table of content: (NPI 1104161439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104161439 NPI number — DR. DAVID HAHN PSYCHOLOGIST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DAVID HAHN PSYCHOLOGIST PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104161439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1252 BROADWAY
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92021-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-917-2569
Provider Business Mailing Address Fax Number:
866-273-2035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1252 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-917-2569
Provider Business Practice Location Address Fax Number:
866-273-2035
Provider Enumeration Date:
11/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HAHN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
TRACY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-917-2569

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY19168 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7572336 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com