Healthcare Provider Details

I. General information

NPI: 1952919532
Provider Name (Legal Business Name): SARA AHMED, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 702
ANAHEIM CA
92801-2814
US

IV. Provider business mailing address

2581 ALISTER AVE
TUSTIN CA
92782-0913
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-0300
  • Fax: 714-533-0700
Mailing address:
  • Phone: 909-456-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA HUSSAIN AHMED
Title or Position: CEO
Credential: MD
Phone: 909-456-9601