Provider Demographics
NPI:1003850553
Name:HASNAIN, IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:HASNAIN
Suffix:
Gender:M
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:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3070
Mailing Address - Country:US
Mailing Address - Phone:951-737-1000
Mailing Address - Fax:951-737-1558
Practice Address - Street 1:1157 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4392
Practice Address - Country:US
Practice Address - Phone:951-737-1000
Practice Address - Fax:951-737-1558
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732180Medicaid
CA00A732182Medicare PIN
CA110235928Medicare PIN
CAH46026Medicare UPIN