Provider Demographics
NPI:1275640344
Name:MAHFOOZI, HASSAN M (MD)
Entity Type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:M
Last Name:MAHFOOZI
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 1:604 S SUNSET AVE #102
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-338-9000
Mailing Address - Fax:626-338-9022
Practice Address - Street 1:12598 CENTRAL AVE #110
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:909-517-2022
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA327362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A327360Medicare PIN
A32736CMedicare PIN
A87743Medicare UPIN