Provider Demographics
NPI:1427129634
Name:HUSSAIN, MIRAJ M (MD)
Entity type:Individual
Prefix:DR
First Name:MIRAJ
Middle Name:M
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MANDRAKE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2713
Mailing Address - Country:US
Mailing Address - Phone:949-786-2655
Mailing Address - Fax:
Practice Address - Street 1:200 W SANTA ANA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4134
Practice Address - Country:US
Practice Address - Phone:714-347-0460
Practice Address - Fax:714-347-0301
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA035260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics