Provider Demographics
NPI:1174582688
Name:GOLSHAN, HEDYEH MOHAJERIN (MD)
Entity type:Individual
Prefix:
First Name:HEDYEH
Middle Name:MOHAJERIN
Last Name:GOLSHAN
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 1:1850 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8071
Mailing Address - Country:US
Mailing Address - Phone:909-875-1199
Mailing Address - Fax:909-875-1166
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-875-1199
Practice Address - Fax:909-875-1166
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A759230Medicaid
CAH58358Medicare UPIN