MEDICARE: GHADA KASSAB, MD, MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A114457	CA

General Provider Information

NPI Number	:	1568873727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHADA KASSAB, MD, MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	4606 MISSION BAY DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4921
Country	:	US
Telephone Number	:	858-273-2726
Fax Number	:	858-273-2725

Provider Business Practice Location Address
First Line	:	4606 MISSION BAY DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4921
Country	:	US
Telephone Number	:	858-273-2726
Fax Number	:	858-273-2725

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GHADA KASSAB
Credential	:	M.D.
Telephone Number	:	858-273-2726

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	05/01/2024

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