Provider Demographics
NPI:1295781201
Name:HOGHOOGHI, DONNA (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:HOGHOOGHI
Suffix:
Gender:F
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:PO BOX 80391
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8391
Mailing Address - Country:US
Mailing Address - Phone:415-884-3415
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-925-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA702682085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800234701Medicaid
CAP00233783OtherRAILROAD MEDICARE
CA00A702680Medicaid
CA00A702685Medicare PIN
CA00A702689Medicare PIN
CA00A702683Medicare PIN
CA00A702680Medicare PIN
CA00A702686Medicare PIN
CAI00643Medicare UPIN
CA00A702687Medicare PIN
CA00A702684Medicare PIN
CAP00233783OtherRAILROAD MEDICARE