Healthcare Provider Details

I. General information

NPI: 1477356996
Provider Name (Legal Business Name): AHMED KADHIM ALHAMDI SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10295 MOORPARK ST
SPRING VALLEY CA
91978-1515
US

IV. Provider business mailing address

10295 MOORPARK ST
SPRING VALLEY CA
91978-1515
US

V. Phone/Fax

Practice location:
  • Phone: 619-219-1689
  • Fax:
Mailing address:
  • Phone: 619-219-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number9NKZ099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: