Provider Demographics
NPI:1104866748
Name:HUSSAIN, FARABI M (MD)
Entity Type:Individual
Prefix:DR
First Name:FARABI
Middle Name:M
Last Name:HUSSAIN
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0000
Mailing Address - Country:US
Mailing Address - Phone:909-747-0371
Mailing Address - Fax:909-580-1363
Practice Address - Street 1:400 N. PEPPER AVE.
Practice Address - Street 2:SURGERY - MOB 308
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-3353
Practice Address - Fax:909-580-1363
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60613208600000X
CAA6061302086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606131Medicaid
CA00A606130CMedicaid
CAZZZ13858ZMedicare Oscar/Certification
CA00A606130CMedicare PIN
CAH40222Medicare UPIN