Provider Demographics
NPI:1629251350
Name:HEDYEH M GOLSHAN MD AND ASSOCIATES INC
Entity Type:Organization
Organization Name:HEDYEH M GOLSHAN MD AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDYEH
Authorized Official - Middle Name:MOHAJERIN
Authorized Official - Last Name:GOLSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-875-1199
Mailing Address - Street 1:1850 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8071
Mailing Address - Country:US
Mailing Address - Phone:909-875-1199
Mailing Address - Fax:909-875-1166
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-875-1199
Practice Address - Fax:909-875-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A759230Medicaid
CA00A759230Medicaid