Provider Demographics
NPI:1265692628
Name:AFSHAR, HASSAN J
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:J
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11053
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5017
Mailing Address - Country:US
Mailing Address - Phone:949-642-3248
Mailing Address - Fax:
Practice Address - Street 1:22471 ASPAN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1642
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist