Provider Demographics
NPI:1528010998
Name:HASAN, SYED AMJAD (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:AMJAD
Last Name:HASAN
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 1:44835 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3102
Mailing Address - Country:US
Mailing Address - Phone:661-940-9555
Mailing Address - Fax:661-940-9550
Practice Address - Street 1:44835 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3102
Practice Address - Country:US
Practice Address - Phone:661-940-9555
Practice Address - Fax:661-940-9550
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH20792Medicare UPIN