MEDICARE: SHAZIA M HASAN MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A55223	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE9271	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1215965207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAZIA M HASAN MD INC

Provider Business Mailing Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	SUITE 400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-675-1400
Fax Number	:	310-675-1402

Provider Business Practice Location Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	SUITE 400
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-675-1400
Fax Number	:	310-675-1402

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAZIA MAHMOOD HASAN
Credential	:	M.D.
Telephone Number	:	310-675-1400

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/16/2009

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Directions to “SHAZIA M HASAN MD INC ” Practice Location

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