Healthcare Provider Details

I. General information

NPI: 1811170400
Provider Name (Legal Business Name): MOHAMMAD A. KAMAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 07/06/2024
Certification Date: 07/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 S FAIR OAKS AVE
PASADENA CA
91105-2626
US

IV. Provider business mailing address

968 S FAIR OAKS AVE
PASADENA CA
91105-2626
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5339
  • Fax: 866-296-6833
Mailing address:
  • Phone: 626-744-5339
  • Fax: 866-296-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D1098267
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA71874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: