Healthcare Provider Details

I. General information

NPI: 1639551435
Provider Name (Legal Business Name): JAAFAR AL-DAHWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 MURPHY CANYON RD STE 120
SAN DIEGO CA
92123-4411
US

IV. Provider business mailing address

PO BOX 421199
SAN DIEGO CA
92142-1199
US

V. Phone/Fax

Practice location:
  • Phone: 858-268-1111
  • Fax: 858-268-0761
Mailing address:
  • Phone: 858-268-1111
  • Fax: 858-268-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA168763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60882397
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA168763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: