Provider Demographics
NPI:1386875334
Name:HAHN, STEPHAN NICHOLAS (LAC)
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:NICHOLAS
Last Name:HAHN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 HERMITAGE AVE
Mailing Address - Street 2:#102
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4264
Mailing Address - Country:US
Mailing Address - Phone:818-825-0698
Mailing Address - Fax:
Practice Address - Street 1:5255 HERMITAGE AVE
Practice Address - Street 2:#102
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4264
Practice Address - Country:US
Practice Address - Phone:818-825-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist