Provider Demographics
NPI:1720208184
Name:HOSEIN, HAZEM (MD)
Entity Type:Individual
Prefix:DR
First Name:HAZEM
Middle Name:
Last Name:HOSEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4834 VIA COLINA
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5020
Mailing Address - Country:US
Mailing Address - Phone:323-344-9848
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTHERN CALIFORNIA
Practice Address - Street 2:1500 SAN PABLO STREET
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1402062085R0202X
CAA912562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0415667Medicaid