Provider Demographics
NPI:1609936483
Name:RASTEGAR, JOHN HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HASSAN
Last Name:RASTEGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HASSAN
Other - Middle Name:
Other - Last Name:RASTEGAR-FARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27547
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2547
Mailing Address - Country:US
Mailing Address - Phone:323-228-4399
Mailing Address - Fax:323-871-2957
Practice Address - Street 1:1300 NORTH VERMONT
Practice Address - Street 2:SUITE 310
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-228-4399
Practice Address - Fax:323-871-2957
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A538471Medicaid
CA00A538471Medicaid
G54978Medicare UPIN