Provider Demographics
NPI:1952458929
Name:HAZZAN, SAMAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:R
Last Name:HAZZAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8510 BALBOA BLVD 150
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5810
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-654-3417
Practice Address - Street 1:777 FLOWER ST
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3015
Practice Address - Country:US
Practice Address - Phone:818-637-2000
Practice Address - Fax:818-242-8761
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38616207R00000X
CAA73965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A739650Medicaid
CA00A739650Medicaid
CAWA73965CMedicare PIN
CAWA73965BMedicare PIN
CACZ945ZMedicare PIN