Provider Demographics
NPI:1629220173
Name:HAZEM Y AFIFI MD INCORPORATED
Entity Type:Organization
Organization Name:HAZEM Y AFIFI MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AFIFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-751-1040
Mailing Address - Street 1:2549 EASTBLUFF DR STE B
Mailing Address - Street 2:477
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3500
Mailing Address - Country:US
Mailing Address - Phone:714-751-1040
Mailing Address - Fax:714-751-1042
Practice Address - Street 1:2200 E FRUIT ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4479
Practice Address - Country:US
Practice Address - Phone:714-751-1040
Practice Address - Fax:714-973-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86053208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV852AOtherMEDICARE PTAN
NV002018520Medicaid
NVV100133Medicare PIN
CABV852AOtherMEDICARE PTAN