Healthcare Provider Details

I. General information

NPI: 1184469603
Provider Name (Legal Business Name): NADIN BASSAM ABU KHALAF MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WHIPPLE RD
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

3555 WHIPPLE RD
UNION CITY CA
94587-1507
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-4010
  • Fax:
Mailing address:
  • Phone: 510-675-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41379
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02923L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: