Provider Demographics
NPI:1174551964
Name:HOGAN, ANJANETTE M (MD)
Entity type:Individual
Prefix:DR
First Name:ANJANETTE
Middle Name:M
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 W REGENT ST
Mailing Address - Street 2:UNIT 319
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1080
Mailing Address - Country:US
Mailing Address - Phone:310-463-5338
Mailing Address - Fax:
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE #409
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-532-0308
Practice Address - Fax:310-532-0889
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732200Medicare ID - Type Unspecified