Jacob Johnson Hanseen, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

103563 Issued in CA

Practice address

175 N Pennsylvania Ave
Glendora, CA 91741-3316

Phone

(626) 963-4173

NPI assigned

Feb 25, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hanseen Orthodontics

  • Dental Clinic/Center
  • Glendora, CA
  • NPI 1760166425
  NPD Authorized official
• Sohal and Pham Dental Corporation

  • Dentist
  • Perris, CA
  • NPI 1013456235
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1295292340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 MAGNOLIA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802206014",
            "telephone_number": "801-918-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N PENNSYLVANIA AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413316",
            "telephone_number": "626-963-4173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1820 N Perris Blvd Ste 70",
            "address_purpose": "LOCATION",
            "city": "Perris",
            "state": "CA",
            "postal_code": "925712714",
            "country_code": "US",
            "telephone_number": "951-349-4106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSEEN",
        "first_name": "JACOB",
        "middle_name": "JOHNSON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-25",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "103563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ibrahim Issa Hanna, M.D.
• Robert Hanna, D.D.S
• Hannan Chiropractic Center,Inc
• Forrest Eugene Hannan, D.C.
• Hanseen Orthodontics
• Happy Med Inc.
• Happy Med Inc.
• Harry Pages DDS Dental Corporation
• Terra Hart
• Marissa Hartel, PSYD

• Orthodontics and Dentofacial Orthopedics Dentistry in Glendora, CA
• Providers in Glendora, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.