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General NPI Number Information
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NPI Number | 1396158648
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Entity Type | Individual
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Provider Name | RAJAIE GEORGE HAZBOUN M.D., M.B.A
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Gender | Male
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 2400 CLAY ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1809
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Country | US
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Telephone | 415-567-7000
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Fax | 415-567-7011
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Provider Business Mailing Address
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Address Line | PO BOX 19638
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9638
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Country | US
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Telephone | 217-545-4401
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Fax | 217-545-1793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A143928
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | A143928
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License Number State | CA
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