Provider Demographics
NPI:1558497891
Name:HADI, GHASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:
Last Name:HADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 DEL MARINO
Mailing Address - Street 2:P.O.BOX 279
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1106
Mailing Address - Country:US
Mailing Address - Phone:909-981-8904
Mailing Address - Fax:909-981-8943
Practice Address - Street 1:1060 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4027
Practice Address - Country:US
Practice Address - Phone:909-981-8904
Practice Address - Fax:909-981-8943
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43603Medicare UPIN