Healthcare Provider Details

I. General information

NPI: 1215066881
Provider Name (Legal Business Name): KAMBIZ HAMRANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 PALM AVE
SAN DIEGO CA
92154-1664
US

IV. Provider business mailing address

PO BOX 1800
LA JOLLA CA
92038-1800
US

V. Phone/Fax

Practice location:
  • Phone: 858-429-1800
  • Fax: 858-459-0045
Mailing address:
  • Phone: 858-459-1800
  • Fax: 858-459-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA42928
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: