Provider Demographics
NPI:1962113464
Name:HAGOS, BINIAM G
Entity type:Individual
Prefix:
First Name:BINIAM
Middle Name:G
Last Name:HAGOS
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 1:4782 CAMPBELL AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1859
Mailing Address - Country:US
Mailing Address - Phone:669-294-0736
Mailing Address - Fax:
Practice Address - Street 1:4782 CAMPBELL AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1859
Practice Address - Country:US
Practice Address - Phone:669-294-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)