Healthcare Provider Details

I. General information

NPI: 1932223831
Provider Name (Legal Business Name): KAZI HABIBUR RAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

IV. Provider business mailing address

1121 SUSSEX CIR
BAKERSFIELD CA
93311-1165
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-8400
  • Fax:
Mailing address:
  • Phone: 661-414-5286
  • Fax: 661-339-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA86409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: