MEDICARE: DR. AISAN RAISDANA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A148429	CA

General Provider Information

NPI Number	:	1710220777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AISAN RAISDANA MD

Provider Business Mailing Address
First Line	:	2923 BRADLEY STREET
Second Line	:	SUITE 120
City	:	PASADENA
State	:	CA
Zip	:	91107
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2923 BRADLEY ST STE 120
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1503
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	07/21/2022

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