Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A70780 | CA |
NPI | 1023036068 |
---|---|
Provider Name | Hamid Reza Hajmomenian |
First Address | Los Angeles, CA 90045-5632 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A707800 | (05) | CA |
H64144 | (02) | CA |