Provider Demographics
NPI:1073588737
Name:NASR, HUGH SHANG (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:SHANG
Last Name:NASR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOOSHANG
Other - Middle Name:
Other - Last Name:NASR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1401 N PALM CANYON DRIVE
Mailing Address - Street 2:101
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-320-6027
Mailing Address - Fax:760-320-4820
Practice Address - Street 1:1401 N PALM CANYON DRIVE
Practice Address - Street 2:101
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-320-6027
Practice Address - Fax:760-320-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46203207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G462030Medicaid
CA00G462030Medicaid
A89830Medicare UPIN