Provider Demographics
NPI:1619929056
Name:HAUG, KERN HANSEN (PT)
Entity type:Individual
Prefix:MR
First Name:KERN
Middle Name:HANSEN
Last Name:HAUG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30836 COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-8136
Mailing Address - Country:US
Mailing Address - Phone:949-499-9559
Mailing Address - Fax:949-499-1845
Practice Address - Street 1:30836 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-8136
Practice Address - Country:US
Practice Address - Phone:949-499-9559
Practice Address - Fax:949-499-1845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist