Provider Demographics
NPI:1568581726
Name:HASAN, FARAH SULTANA (MD)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:SULTANA
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E LOS ANGELES
Mailing Address - Street 2:STE 100
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2898
Mailing Address - Country:US
Mailing Address - Phone:805-522-3782
Mailing Address - Fax:
Practice Address - Street 1:1350 E LOS ANGELES
Practice Address - Street 2:STE 100
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2898
Practice Address - Country:US
Practice Address - Phone:805-522-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A892450Medicaid
CACB208572Medicare PIN