Healthcare Provider Details

I. General information

NPI: 1952368409
Provider Name (Legal Business Name): CORY KHURRAM HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KHURRAM HUSSAIN M.D.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/14/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 125
SAN FRANCISCO CA
94114-1032
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-4900
  • Fax: 415-369-1365
Mailing address:
  • Phone: 415-600-4900
  • Fax: 415-369-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40764
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35123218
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC145278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: