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General NPI Number Information
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NPI Number | 1871893693
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Entity Type | Organization
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Legal Business Name | MOSAJIL MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 1599 TARA HILLS DR LASER SURGERY CENTER
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City | PINOLE
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State | CA
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Zip | 94564-2519
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Country | US
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Telephone | 510-724-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 5887 MARGARIDO DR
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City | OAKLAND
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State | CA
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Zip | 94618-1834
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Country | US
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Telephone | 510-652-5549
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAM KHAN
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Credential | M.D.
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Telephone | 510-652-5549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | C2628504
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License Number State | CA
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