1639231871 NPI number — KHAILA MAJED HADDADIN MFTI

Table of content: KHAILA MAJED HADDADIN MFTI (NPI 1639231871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639231871 NPI number — KHAILA MAJED HADDADIN MFTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDADIN
Provider First Name:
KHAILA
Provider Middle Name:
MAJED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABBASSI
Provider Other First Name:
KHAILA
Provider Other Middle Name:
MAJED
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639231871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 COOLIDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94602-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-773-7076
Provider Business Mailing Address Fax Number:
510-530-2047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 COOLIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94602-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-773-7076
Provider Business Practice Location Address Fax Number:
510-530-2047
Provider Enumeration Date:
12/14/2006

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: 106H00000X , with the licence number:  44098 , 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: 8209 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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