Healthcare Provider Details

I. General information

NPI: 1356710560
Provider Name (Legal Business Name): YASIR NUMAN TASHKANDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAMC - INTENSIVE CARE DEPARTMENT INTERNAL CODE 6424
JEDDAH MAKKAH
21423
SA

IV. Provider business mailing address

4818 IBRAHIM IBN ALMUFLIH RD
JEDDAH MAKKAH
22431
SA

V. Phone/Fax

Practice location:
  • Phone: 966122266666
  • Fax:
Mailing address:
  • Phone: 966532222470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301065626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: