Healthcare Provider Details

I. General information

NPI: 1003350265
Provider Name (Legal Business Name): HANI ALSERGANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KING FAISAL SPECIALIST HOSPITAL. HEART CENTER. TAKASUSSI STREET. MBC 16
RIYADH CENTRAL
11211
SA

IV. Provider business mailing address

KING FAISAL SPECIALIST HOSPITAL. HEART CENTER MBC 16 PO BOX 3354
RIYADH CENTRAL
11211
SA

V. Phone/Fax

Practice location:
  • Phone: 966114647272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101261385
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: