Healthcare Provider Details

I. General information

NPI: 1083441331
Provider Name (Legal Business Name): ISAM SUDEEK HUSSEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 CAMPUS DR APT 320
DALY CITY CA
94015-4929
US

IV. Provider business mailing address

860 CAMPUS DR APT 320
DALY CITY CA
94015-4929
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-8080
  • Fax:
Mailing address:
  • Phone: 650-355-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: