=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487099156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ENT - HEAD & NECK SURGERY, PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2013
-----------------------------------------------------
Last Update Date | 05/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38660 MEDICAL CENTER DR STE A200
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-4385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-262-9150
-----------------------------------------------------
Fax | 888-959-4959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 453 QUESTA CT
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-262-9150
-----------------------------------------------------
Fax | 888-959-4959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DR. ZAIN KADRI
-----------------------------------------------------
Credential | MD, FACS
-----------------------------------------------------
Telephone | 310-433-4050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0007X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
-----------------------------------------------------
License Number | A34819
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------