Healthcare Provider Details

I. General information

NPI: 1972715381
Provider Name (Legal Business Name): ABDULLAH KHAN GHOURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

16393 EL REVINO DR
FONTANA CA
92336-5840
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-4520
  • Fax: 909-881-4526
Mailing address:
  • Phone: 347-200-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA96810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: