Provider Demographics
NPI:1851616064
Name:HERTZOG, HANS DIETER (MD)
Entity type:Individual
Prefix:DR
First Name:HANS
Middle Name:DIETER
Last Name:HERTZOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HANS
Other - Middle Name:DIETER
Other - Last Name:HERTZOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5094 E LOS COYOTES DIAGONAL
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2839
Mailing Address - Country:US
Mailing Address - Phone:562-597-3100
Mailing Address - Fax:
Practice Address - Street 1:5094 E LOS COYOTES DIAGONAL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2839
Practice Address - Country:US
Practice Address - Phone:562-597-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118549207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology