Provider Demographics
NPI:1154441343
Name:ALFRED A SIDHOM M D INC
Entity Type:Organization
Organization Name:ALFRED A SIDHOM M D INC
Other - Org Name:ADVANCED UROLOGY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-776-7090
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:502
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2815
Mailing Address - Country:US
Mailing Address - Phone:714-776-7090
Mailing Address - Fax:714-776-5632
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:502
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-776-7090
Practice Address - Fax:714-776-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty