1154441343 NPI number — ALFRED A SIDHOM M D INC

Table of content: (NPI 1154441343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154441343 NPI number — ALFRED A SIDHOM M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFRED A SIDHOM M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED UROLOGY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154441343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 W LA PALMA AVE
Provider Second Line Business Mailing Address:
502
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92801-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-776-7090
Provider Business Mailing Address Fax Number:
714-776-5632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 W LA PALMA AVE
Provider Second Line Business Practice Location Address:
502
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-776-7090
Provider Business Practice Location Address Fax Number:
714-776-5632
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIDHOM
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
714-776-7090

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A35526 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com