=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609198035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN ANTONIO MEDICAL CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2010
-----------------------------------------------------
Last Update Date | 02/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 W. 17TH STREET
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-4090
-----------------------------------------------------
Fax | 714-541-8815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 6098
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-4090
-----------------------------------------------------
Fax | 714-541-8815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL PROVIDER
-----------------------------------------------------
Name | ZIAD LUTFI KHARUF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-541-4090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A26536
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------