Provider Demographics
NPI:1750331179
Name:DJALILIAN, HAMID REZA (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:REZA
Last Name:DJALILIAN
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 1:101 THE CITY DR S
Mailing Address - Street 2:BLDG 56, SUITE 500 RTE 81
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-5753
Mailing Address - Fax:714-456-2280
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 56, SUITE 500 RTE 81
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5753
Practice Address - Fax:714-456-2280
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85665207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A856650Medicaid
CAWA85665AMedicare ID - Type UnspecifiedNHIC
CA00A856650Medicaid