Healthcare Provider Details

I. General information

NPI: 1790892230
Provider Name (Legal Business Name): M MASH-HOORDIN RAJUDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W ORANGE AVE STE 204
ANAHEIM CA
92804-3154
US

IV. Provider business mailing address

3055 W ORANGE AVE STE 204
ANAHEIM CA
92804-3154
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-9500
  • Fax: 714-229-9904
Mailing address:
  • Phone: 714-229-9500
  • Fax: 714-229-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA26154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: