Provider Demographics
NPI:1578519989
Name:HASSAN, ALLEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:C
Last Name:HASSAN
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 1:2929 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6012
Mailing Address - Country:US
Mailing Address - Phone:916-971-3900
Mailing Address - Fax:916-971-3618
Practice Address - Street 1:2929 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6012
Practice Address - Country:US
Practice Address - Phone:916-971-3900
Practice Address - Fax:916-971-3618
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C298160Medicaid
CA680018623OtherCOMMERICAL INSURANCE
CA00C298160Medicare ID - Type Unspecified
CAA34041Medicare UPIN