Provider Demographics
NPI:1396899977
Name:HOMAN HAJBANDEH, M.D., P.L.L.C
Entity type:Organization
Organization Name:HOMAN HAJBANDEH, M.D., P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJBANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-722-2595
Mailing Address - Street 1:255 S DOBSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6231
Mailing Address - Country:US
Mailing Address - Phone:480-722-2595
Mailing Address - Fax:480-722-2599
Practice Address - Street 1:255 S DOBSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6231
Practice Address - Country:US
Practice Address - Phone:480-722-2595
Practice Address - Fax:480-722-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00304798OtherRAILROAD MEDICARE
AZ695166Medicaid
AZH07819Medicare UPIN
AZZ70227Medicare PIN