Provider Demographics
NPI:1033394408
Name:AHMED, RASIQ ABDUL JABBAR (MD)
Entity Type:Individual
Prefix:
First Name:RASIQ
Middle Name:ABDUL JABBAR
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RASIQ
Other - Middle Name:ABDUL JABBAR
Other - Last Name:AHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5400 ORANGETHORPE AVE
Mailing Address - Street 2:#51
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1051
Mailing Address - Country:US
Mailing Address - Phone:714-932-1314
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT STREET KAISER PERMANENTE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:800-541-7946
Practice Address - Fax:626-405-2675
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist