Provider Demographics
NPI:1083673644
Name:KAZEM, FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:KAZEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 MINORCA CV
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2933
Mailing Address - Country:US
Mailing Address - Phone:858-546-3800
Mailing Address - Fax:858-546-3900
Practice Address - Street 1:14212 MINORCA CV
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2933
Practice Address - Country:US
Practice Address - Phone:858-546-3800
Practice Address - Fax:858-546-3900
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA846582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI07114Medicare UPIN
CAWA84658CMedicare ID - Type UnspecifiedGROUP#W7168