MEDICARE: DR. THOMAS KHOURI HADDAD 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	207RG0100X	Gastroenterology Physician	A953521	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0593636	OTHER	CA	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	LAB93636F	OTHER	CA	MEDICAL CLIA

General Provider Information

NPI Number	:	1932151867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KHOURI HADDAD M.D.

Provider Business Mailing Address
First Line	:	91 COMMONWEALTH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2601
Country	:	US
Telephone Number	:	646-831-3160
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 HYDE ST
Second Line	:	SUITE 125
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4822
Country	:	US
Telephone Number	:	415-771-4366
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/10/2022

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