Basic Information
| Provider Information | |||||||||
| NPI: | 1891723912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAJJAR | ||||||||
| FirstName: | IHAB | ||||||||
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| Credential: | MD,MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0471217634 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5303 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753905310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234425100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 227075 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 70835 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 2084N0400X | T7425 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 207RG0300X | C54104 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0100430 | 01 | CA | GROUP MEDI-CAL | OTHER | 1902846306 | 01 | CA | GROUP NPI | OTHER | W18762 | 01 | CA | GROUP MEDICARE | OTHER |