Provider Demographics
NPI:1093795239
Name:KABEER, MUSTAFA HUSEN (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:HUSEN
Last Name:KABEER
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 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4509
Mailing Address - Country:US
Mailing Address - Phone:714-364-4050
Mailing Address - Fax:714-364-4051
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:SUITE 225
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4509
Practice Address - Country:US
Practice Address - Phone:714-364-4050
Practice Address - Fax:714-364-4051
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG868622086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G868620Medicaid
CA00G868620Medicaid
CAG10564Medicare UPIN