Provider Demographics
NPI:1669470753
Name:AISEN, PAUL STEPHEN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STEPHEN
Last Name:AISEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DR
Mailing Address - Street 2:UCSD MEDICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8201
Mailing Address - Country:US
Mailing Address - Phone:858-622-2028
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ARBOR DR MC 0949
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-0949
Practice Address - Country:US
Practice Address - Phone:858-622-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88220207RG0300X, 2084N0400X
DC313772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD373200200Medicaid
130022342OtherMEDICARE RAILROAD
DC029728100Medicaid
VA5842174Medicaid
MD373200200Medicaid
DC000Y34G93Medicare PIN