Provider Demographics
NPI:1093934556
Name:KENT H AZAREN MD INC
Entity Type:Organization
Organization Name:KENT H AZAREN MD INC
Other - Org Name:ASSOCIATES IN GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-424-0421
Mailing Address - Street 1:701 EAST 28TH STREET #201
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-424-0421
Mailing Address - Fax:562-427-8005
Practice Address - Street 1:701 EAST 28TH STREET
Practice Address - Street 2:#201
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-424-0421
Practice Address - Fax:562-427-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079620Medicaid
CAGR0079620Medicaid
CAW13478Medicare ID - Type Unspecified
CAG02226Medicare UPIN
CAA92153Medicare UPIN