MEDICARE: DR. NAOUM A BALADI M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	30663	WV
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A43839	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A43839	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1295740173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAOUM A BALADI M.D.

Provider Business Mailing Address
First Line	:	1800 SULLIVAN AVE STE 407
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2231
Country	:	US
Telephone Number	:	650-636-4462
Fax Number	:	650-636-4463

Provider Business Practice Location Address
First Line	:	1800 SULLIVAN AVE
Second Line	:	SUITE 407
City	:	DALY CITY
State	:	CA
Zip	:	94015-2231
Country	:	US
Telephone Number	:	650-636-4462
Fax Number	:	650-636-4463

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/21/2024

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