Provider Demographics
NPI:1851355473
Name:HASHEMI, RAY H (MD PHD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:H
Last Name:HASHEMI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492387
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8387
Mailing Address - Country:US
Mailing Address - Phone:661-949-8111
Mailing Address - Fax:661-940-0864
Practice Address - Street 1:43731 N 15 ST WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-949-8111
Practice Address - Fax:661-940-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG717422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717422Medicaid
CAG71742BMedicare ID - Type Unspecified
CA00G717422Medicaid