Healthcare Provider Details

I. General information

NPI: 1861683286
Provider Name (Legal Business Name): JAMAL Y HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE 2ND FL, NICU
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

501 E 27TH 202
LONG BEACH CA
90806
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8750
  • Fax: 562-933-8014
Mailing address:
  • Phone: 562-933-8750
  • Fax: 562-933-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA86663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: