1750326427 NPI number — DR. TARA HANJAN MD

Table of content: DR. TARA HANJAN MD (NPI 1750326427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750326427 NPI number — DR. TARA HANJAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANJAN
Provider First Name:
TARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1750326427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35800 BOB HOPE DR
Provider Second Line Business Mailing Address:
SUITE 150A
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-1739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-770-1920
Provider Business Mailing Address Fax Number:
760-324-0848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35800 BOB HOPE DR
Provider Second Line Business Practice Location Address:
SUITE 150A
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-770-1920
Provider Business Practice Location Address Fax Number:
760-324-0848
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  227925-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 227925-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8691908 . This is a "MEDICAID GROUP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: W35021 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02186203 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2572521 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: W34991 . This is a "MEDICARE GROUP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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