1174671499 NPI number — SHAIK M. SAHEB, MD, INC.

Table of content: (NPI 1174671499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174671499 NPI number — SHAIK M. SAHEB, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAIK M. SAHEB, MD, 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:
ORTHOPEDIC AND SPORTS MEDICINE 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:
1174671499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9227 RESEDA BLVD STE 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91324-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-259-8010
Provider Business Mailing Address Fax Number:
661-259-8793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18546 ROSCOE BLVD STE 220A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-4663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-4403
Provider Business Practice Location Address Fax Number:
661-259-8793
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MAHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-259-8010

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W13286A . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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