Provider Demographics
NPI:1902689334
Name:HOSSEINIAN, JAHAN MOHAZAB
Entity Type:Individual
Prefix:
First Name:JAHAN
Middle Name:MOHAZAB
Last Name:HOSSEINIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SAN SIMEON
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7950
Mailing Address - Country:US
Mailing Address - Phone:949-547-4148
Mailing Address - Fax:
Practice Address - Street 1:26 SAN SIMEON
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7950
Practice Address - Country:US
Practice Address - Phone:949-547-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Multi-Specialty