Healthcare Provider Details

I. General information

NPI: 1073924056
Provider Name (Legal Business Name): HOOMAN YONATAN SAZEGAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 155
PASADENA CA
91105-3027
US

IV. Provider business mailing address

10 CONGRESS ST STE 155
PASADENA CA
91105-3027
US

V. Phone/Fax

Practice location:
  • Phone: 626-486-0181
  • Fax: 626-486-0189
Mailing address:
  • Phone: 626-486-0181
  • Fax: 626-486-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSL1021
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDO2226
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: