Provider Demographics
NPI:1053456285
Name:HITI, ALAN L (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:HITI
Suffix:
Gender:M
Credentials:MD, PHD
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-4815
Mailing Address - Fax:
Practice Address - Street 1:2250 ALCAZAR ST
Practice Address - Street 2:CSC-108
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-9064
Practice Address - Country:US
Practice Address - Phone:323-442-2920
Practice Address - Fax:323-442-2990
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41833207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41833OtherSTATE LICENSE
CAZZZ310292ZOtherBLUE SHIELD
CA000G52770Medicaid
CAWA41833AMedicare PIN
CA000G52770Medicaid