Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A109426 | CA |
NPI | 1184914525 |
---|---|
Provider Name | Dr. Iqbal Ismail Kasam |
First Address | Northridge, CA 91326-4171 |
Second Address | Palmdale, CA 93551-3649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 03/11/2021 |