Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 01069398A | IN |
N | 207N00000X | Dermatologist | 11013338A | IN |
Y | 207N00000X | Dermatologist | A114457 | CA |
NPI | 1023278504 |
---|---|
Provider Name | Dr. Ghada K Kassab |
First Address | San Diego, CA 92117-5493 |
Second Address | San Diego, CA 92117-5493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 28/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000720044 | ANTHEM PROVIDER NUMBER (01) | IN |
201024080 | (05) | IN |