1639146699 NPI number — HEBA SAMIR KAMAL MD

Table of content: HEBA SAMIR KAMAL MD (NPI 1639146699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639146699 NPI number — HEBA SAMIR KAMAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMAL
Provider First Name:
HEBA
Provider Middle Name:
SAMIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1639146699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-600-2200
Provider Business Mailing Address Fax Number:
415-750-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-600-2200
Provider Business Practice Location Address Fax Number:
415-750-5001
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X , with the licence number:  A68946 , 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)

  • Identifier: 00A689460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".