Provider Demographics
NPI:1245358969
Name:HASSID, MEHRDAD (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:HASSID
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 1:8920 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 618
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-967-3050
Mailing Address - Fax:310-967-3051
Practice Address - Street 1:8920 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 618
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-967-3050
Practice Address - Fax:310-967-3051
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080322207Q00000X, 208600000X
CAG803222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH41638Medicare UPIN
CAG80322Medicare ID - Type Unspecified