Provider Demographics
NPI:1053326587
Name:HASSAN BOROUJERDI MD INC
Entity Type:Organization
Organization Name:HASSAN BOROUJERDI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOROUJERDI-RAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-907-7616
Mailing Address - Street 1:14350 WHITTIER BLVD
Mailing Address - Street 2:101
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2138
Mailing Address - Country:US
Mailing Address - Phone:562-907-7616
Mailing Address - Fax:562-907-7615
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:101
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2138
Practice Address - Country:US
Practice Address - Phone:562-907-7616
Practice Address - Fax:562-907-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55053207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550530Medicaid
F62268Medicare UPIN
CA00A550530Medicaid