Healthcare Provider Details

I. General information

NPI: 1801295977
Provider Name (Legal Business Name): ESAM ABDULLAH ALBANYAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22490 KING ABDULAZIZ MEDICAL CITY-NGHA DEPT. OF PEDIATRICS MC1510
RIYADH KHASHM ALAAN
11426
SA

IV. Provider business mailing address

PO BOX 22490 KING ABDULAZIZ MEDICAL CITY-NGHA DEPT. OF PEDIATRICS MC1510
RIYADH KHASHM ALAAN
11426
SA

V. Phone/Fax

Practice location:
  • Phone: 9661180111111
  • Fax:
Mailing address:
  • Phone: 9661180111111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301073490
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8160
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number8160
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: