Provider Demographics
NPI:1982867271
Name:HAJARIAN, HAMID CYRUS (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:CYRUS
Last Name:HAJARIAN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7514
Mailing Address - Country:US
Mailing Address - Phone:714-540-1191
Mailing Address - Fax:714-540-0470
Practice Address - Street 1:11100 WARNER AVE STE 370
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7514
Practice Address - Country:US
Practice Address - Phone:714-540-1191
Practice Address - Fax:714-540-0470
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452621223S0112X
CAA68648204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982867271OtherDENTI-CAL