Healthcare Provider Details

I. General information

NPI: 1720573835
Provider Name (Legal Business Name): RAZAN HUSAM KAILEH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 03/21/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S MADERA AVE
KERMAN CA
93630-1537
US

IV. Provider business mailing address

449 S MADERA AVE
KERMAN CA
93630-1537
US

V. Phone/Fax

Practice location:
  • Phone: 559-364-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: