Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A111137 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A111137 | CA |
N | 207ND0900X | Dermatopathologist | A111137 | CA |
N | 207NS0135X | Procedural Dermatology | A111137 | CA |
NPI | 1023272309 |
---|---|
Provider Name | Khaled Mahmoud Hassan |
First Address | Fullerton, CA 92835-2609 |
Second Address | Fullerton, CA 92835-2609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 03/11/2021 |