=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811252844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOHAMMAD HOSSAIN MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2012
-----------------------------------------------------
Last Update Date | 07/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 BROOKSIDE AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-793-4443
-----------------------------------------------------
Fax | 909-793-8783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 BROOKSIDE AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-793-4443
-----------------------------------------------------
Fax | 909-793-8783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMMAD HOSSAIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-793-4443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A341010
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------