Healthcare Provider Details

I. General information

NPI: 1982807657
Provider Name (Legal Business Name): HAMID KHORASANI FAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 ATLANTIC AVE
LONG BEACH CA
90807-3418
US

IV. Provider business mailing address

PO BOX 17369
LONG BEACH CA
90807-7369
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-8814
  • Fax: 562-427-2604
Mailing address:
  • Phone: 562-424-8814
  • Fax: 562-427-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number50031
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: