Healthcare Provider Details

I. General information

NPI: 1346228780
Provider Name (Legal Business Name): TAHIR HASSAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W YOSEMITE AVE
MADERA CA
93637-4551
US

IV. Provider business mailing address

708 W YOSEMITE AVE
MADERA CA
93637-4551
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-1111
  • Fax: 559-673-1414
Mailing address:
  • Phone: 559-673-1111
  • Fax: 559-673-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC51092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: