Healthcare Provider Details

I. General information

NPI: 1902895931
Provider Name (Legal Business Name): AASIM KAMAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W NORTHERN AVE STE C203
PHOENIX AZ
85021-4929
US

IV. Provider business mailing address

2226 W NORTHERN AVE STE C203
PHOENIX AZ
85021-4929
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-2020
  • Fax: 602-942-2121
Mailing address:
  • Phone: 602-942-2020
  • Fax: 602-942-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30886
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: