Healthcare Provider Details

I. General information

NPI: 1144562836
Provider Name (Legal Business Name): MOHAMMED HASSAN AL-TEMIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 SAMARITAN CT STE H
SAN JOSE CA
95124-4002
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 408-752-4088
  • Fax: 408-752-4253
Mailing address:
  • Phone: 317-962-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA138126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: