Provider Demographics
NPI:1730234717
Name:HANSON MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:HANSON MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DURDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-294-2070
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7603
Mailing Address - Country:US
Mailing Address - Phone:626-294-2070
Mailing Address - Fax:626-294-2076
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-294-2070
Practice Address - Fax:626-294-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A319930Medicaid
CAZZZ49871ZOtherBLUE SHIELD
CAD19503Medicare UPIN
CA00A319930Medicaid