Healthcare Provider Details

I. General information

NPI: 1154844298
Provider Name (Legal Business Name): MOHAMMED A KADHEM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 354
LA MESA CA
91942-3027
US

IV. Provider business mailing address

1643 AVENIDA LADERA
EL CAJON CA
92020-1305
US

V. Phone/Fax

Practice location:
  • Phone: 818-442-7332
  • Fax:
Mailing address:
  • Phone: 818-442-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number101609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: