1295740173 NPI number — DR. NAOUM A BALADI M.D.

Table of content: DR. NAOUM A BALADI M.D. (NPI 1295740173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295740173 NPI number — DR. NAOUM A BALADI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALADI
Provider First Name:
NAOUM
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
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:
1295740173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 SULLIVAN AVE STE 407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-636-4462
Provider Business Mailing Address Fax Number:
650-636-4463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 SULLIVAN AVE
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-636-4462
Provider Business Practice Location Address Fax Number:
650-636-4463
Provider Enumeration Date:
07/29/2006

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: 208G00000X , with the licence number:  30663 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: A43839 , 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: A43839 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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