Provider Demographics
NPI:1447273206
Name:HANSEN, ANNIKEN BOGAARD (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIKEN
Middle Name:BOGAARD
Last Name:HANSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 FREEDOM BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2752
Mailing Address - Country:US
Mailing Address - Phone:831-763-8400
Mailing Address - Fax:
Practice Address - Street 1:1430 FREEDOM BLVD STE D
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2752
Practice Address - Country:US
Practice Address - Phone:831-763-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70530FOtherMEDICAID GROUP
CAZZZ15686ZOtherMEDICARE GROUP