MEDICARE: HASSAN J AZIMI 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	207XS0106X	Orthopaedic Hand Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518589357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASSAN J AZIMI MD INC

Provider Business Mailing Address
First Line	:	8008 FROST ST STE 403
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8008 FROST ST STE 403
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4209
Country	:	US
Telephone Number	:	858-715-9200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HASSAN JON AZIMI
Credential	:	MD
Telephone Number	:	970-380-8583

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	05/14/2020

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