Healthcare Provider Details

I. General information

NPI: 1003979337
Provider Name (Legal Business Name): AZIZ KAMALI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 N CALIFORNIA ST STE A
STOCKTON CA
95204-6029
US

IV. Provider business mailing address

1947 N CALIFORNIA ST STE A
STOCKTON CA
95204-6029
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-5533
  • Fax: 209-475-0187
Mailing address:
  • Phone: 209-478-5533
  • Fax: 209-475-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AZIZ KAMALI
Title or Position: CEO
Credential:
Phone: 209-475-0179