Provider Demographics
NPI:1003979337
Name:AZIZ KAMALI MD INC
Entity Type:Organization
Organization Name:AZIZ KAMALI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-475-0179
Mailing Address - Street 1:4505 PRECISSI LN # 1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6205
Mailing Address - Country:US
Mailing Address - Phone:209-478-5533
Mailing Address - Fax:209-475-0187
Practice Address - Street 1:4505 PRECISSI LN # 1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6205
Practice Address - Country:US
Practice Address - Phone:209-478-5533
Practice Address - Fax:209-475-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA401350174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A401350Medicare PIN