Provider Demographics
NPI:1205814837
Name:BOROUJERDI-RAD, HASSAN (MD)
Entity Type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:
Last Name:BOROUJERDI-RAD
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 1:14350 EAST 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 EAST 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
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55053207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550530Medicaid
CAWA55053EMedicare PIN
CA00A550530Medicaid