Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 14660 | NV |
Y | 2086S0105X | Surgery of the Hand | C15029 | CA |
NPI | 1629283510 |
---|---|
Provider Name | Kenny E. Hanna JR. |
First Address | Las Vegas, NV 89113-3676 |
Second Address | Glendale, CA 91204-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 23/03/2019 |