Provider Demographics
NPI:1790165785
Name:HASANUDDIN, HARRISON (DO)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:
Last Name:HASANUDDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 S GARFIELD AVE UNIT 128
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6891
Mailing Address - Country:US
Mailing Address - Phone:626-215-5335
Mailing Address - Fax:
Practice Address - Street 1:1336 W VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2480
Practice Address - Country:US
Practice Address - Phone:626-281-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT016681207QB0002X, 207QS1201X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine