Provider Demographics
NPI:1982807657
Name:FAR, HAMID KHORASANI (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:KHORASANI
Last Name:FAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17369
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-7369
Mailing Address - Country:US
Mailing Address - Phone:562-424-8814
Mailing Address - Fax:562-427-2604
Practice Address - Street 1:3610 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3418
Practice Address - Country:US
Practice Address - Phone:562-424-8814
Practice Address - Fax:562-427-2604
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50031207QG0300X
CAA102393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN976432000Medicaid
MN976432000Medicaid