MEDICARE: MUHTADA ABDULELAH KAMAL ALDIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	A185612	CA

General Provider Information

NPI Number	:	1073172896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUHTADA ABDULELAH KAMAL ALDIN

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:	916-854-6769

Provider Business Practice Location Address
First Line	:	4722 QUAIL LAKES DR STE B
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-471-1848
Fax Number	:	209-472-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	01/12/2026

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