1073588737 NPI number — HUGH SHANG NASR MD

Table of content: MRS. LAUREN ELIZABETH RODEHEAVER (NPI 1902071228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073588737 NPI number — HUGH SHANG NASR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASR
Provider First Name:
HUGH
Provider Middle Name:
SHANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NASR
Provider Other First Name:
HOOSHANG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073588737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 N PALM CANYON DRIVE
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-320-6027
Provider Business Mailing Address Fax Number:
760-320-4820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 N PALM CANYON DRIVE
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-320-6027
Provider Business Practice Location Address Fax Number:
760-320-4820
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  G46203 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G462030 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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