Provider Demographics
NPI:1225169345
Name:IMAM, ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
Middle Name:
Last Name:IMAM
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 1:10683 MAGNOLIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1893
Mailing Address - Country:US
Mailing Address - Phone:951-351-4026
Mailing Address - Fax:951-351-9982
Practice Address - Street 1:10683 MAGNOLIA AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1893
Practice Address - Country:US
Practice Address - Phone:951-351-4026
Practice Address - Fax:951-351-9982
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35776207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy