1033394408 NPI number — RASIQ ABDUL JABBAR AHMED M.D

Table of content: RASIQ ABDUL JABBAR AHMED M.D (NPI 1033394408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033394408 NPI number — RASIQ ABDUL JABBAR AHMED M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
RASIQ
Provider Middle Name:
ABDUL JABBAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AHAMED
Provider Other First Name:
RASIQ
Provider Other Middle Name:
ABDUL JABBAR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033394408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 ORANGETHORPE AVE
Provider Second Line Business Mailing Address:
#51
Provider Business Mailing Address City Name:
LA PALMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90623-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-932-1314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
393 E WALNUT STREET KAISER PERMANENTE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91188-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-541-7946
Provider Business Practice Location Address Fax Number:
626-405-2675
Provider Enumeration Date:
01/04/2008

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: 174400000X , with the licence number:  A101248 , 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)