Provider Demographics
NPI:1033808613
Name:KINGMAN CANCER CENTER
Entity Type:Organization
Organization Name:KINGMAN CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-882-1384
Mailing Address - Street 1:3555 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3291
Mailing Address - Country:US
Mailing Address - Phone:702-882-1384
Mailing Address - Fax:
Practice Address - Street 1:3555 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3291
Practice Address - Country:US
Practice Address - Phone:702-882-1384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty