Provider Demographics
NPI:1780872366
Name:HASHEMI, ZIA (MD)
Entity type:Individual
Prefix:
First Name:ZIA
Middle Name:
Last Name:HASHEMI
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:PO BOX 1567
Mailing Address - Street 2:ATTN: PACIFIC MEDICAL CLINIC
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-1567
Mailing Address - Country:US
Mailing Address - Phone:323-563-2222
Mailing Address - Fax:323-562-1101
Practice Address - Street 1:4750 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1351
Practice Address - Country:US
Practice Address - Phone:323-563-2222
Practice Address - Fax:323-562-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51569207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515690Medicaid
CA00A515693Medicaid
CA00A515690Medicaid