Healthcare Provider Details

I. General information

NPI: 1053446922
Provider Name (Legal Business Name): NAJAM A AWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/16/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 POSADA LN STE A
TEMPLETON CA
93465-4055
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8844
  • Fax: 805-782-8859
Mailing address:
  • Phone: 805-782-8844
  • Fax: 805-782-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number120156
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29335
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA26106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: