Provider Demographics
NPI:1689626301
Name:GULESSERIAN, HRAIR PUZANT (MD)
Entity Type:Individual
Prefix:MR
First Name:HRAIR
Middle Name:PUZANT
Last Name:GULESSERIAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:393 BLOSSOM HILL ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1653
Mailing Address - Country:US
Mailing Address - Phone:408-578-5831
Mailing Address - Fax:408-578-6076
Practice Address - Street 1:393 BLOSSOM HILL ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1653
Practice Address - Country:US
Practice Address - Phone:408-578-5831
Practice Address - Fax:408-578-6076
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA243412086X0206X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A24341Medicaid
CA00A243410Medicaid
CA00A24341Medicaid
CA00A24341Medicare PIN
CA94-2295361Medicare ID - Type UnspecifiedTAX ID#