MEDICARE: NAVID HAFEZ M.D.

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	207RH0000X	Hematology (Internal Medicine) Physician	1.055360	CT
2	207RH0003X	Hematology & Oncology Physician	1.055360	CT
3	207RX0202X	Medical Oncology Physician	1.055360	CT
4	207RH0003X	Hematology & Oncology Physician	C183871	CA

General Provider Information

NPI Number	:	1740505007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVID HAFEZ M.D.

Provider Business Mailing Address
First Line	:	333 CEDAR ST
Second Line	:	P.O. BOX 208033
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3206
Country	:	US
Telephone Number	:	203-688-2470
Fax Number	:	203-688-4516

Provider Business Practice Location Address
First Line	:	11800 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6602
Country	:	US
Telephone Number	:	310-231-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	06/28/2023

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