Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A80449 | CA |
NPI | 1063497220 |
---|---|
Provider Name | Shahid Hussain |
First Address | La Jolla, CA 92037-8411 |
Second Address | El Centro, CA 92243-3623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A804490 | (05) | CA |
GL123Y | NO. CALIFORNIA PTAN (01) | CA |
GL123Z | SO. CALIFORNIA PTAN (01) | CA |
H77712 | (02) |