Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A56094 | CA |
N | 111NI0900X | Internist | A56094 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | A56094 | CA |
N | 207RI0011X | Interventional Cardiology | A56094 | CA |
NPI | 1093765752 |
---|---|
Provider Name | Dr. Fady I. Malik |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A560940 | (05) | CA |
H42663 | (02) | CA |