Healthcare Provider Details

I. General information

NPI: 1659315729
Provider Name (Legal Business Name): KABIR AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18 ST MARY MEDICAL CENTER
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

20124 SAN VICENTE CIR
WALNUT CA
91789-1843
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone: 626-589-8935
  • Fax: 866-880-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA69357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: