Healthcare Provider Details

I. General information

NPI: 1396158648
Provider Name (Legal Business Name): RAJAIE GEORGE HAZBOUN M.D., M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CLAY ST
SAN FRANCISCO CA
94115-1809
US

IV. Provider business mailing address

PO BOX 19638
SPRINGFIELD IL
62794-9638
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-7000
  • Fax: 415-567-7011
Mailing address:
  • Phone: 217-545-4401
  • Fax: 217-545-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA143928
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA143928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: