Healthcare Provider Details

I. General information

NPI: 1740505007
Provider Name (Legal Business Name): NAVID HAFEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 WILSHIRE BLVD
LOS ANGELES CA
90025-6602
US

IV. Provider business mailing address

333 CEDAR ST P.O. BOX 208033
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-2121
  • Fax:
Mailing address:
  • Phone: 203-688-2470
  • Fax: 203-688-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number1.055360
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1.055360
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1.055360
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC183871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: