Provider Demographics
NPI:1003999145
Name:AL-BUSSAM, NAZAR (MD)
Entity Type:Individual
Prefix:MR
First Name:NAZAR
Middle Name:
Last Name:AL-BUSSAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 BROOKSHIRE AVE
Mailing Address - Street 2:STE 503
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-861-8853
Mailing Address - Fax:562-861-8820
Practice Address - Street 1:11411 BROOKSHIRE AVE
Practice Address - Street 2:STE 503
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-861-8853
Practice Address - Fax:562-861-8820
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A24853Medicare UPIN
CAA26479Medicare ID - Type Unspecified