Provider Demographics
NPI:1235218413
Name:MUSTAQEEM A QAZI MD & THI KIM LOAN PHAM MD
Entity Type:Organization
Organization Name:MUSTAQEEM A QAZI MD & THI KIM LOAN PHAM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAQEEM
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-863-0138
Mailing Address - Street 1:82013 DR CARREON BLVD
Mailing Address - Street 2:SUITE #C
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-863-0138
Mailing Address - Fax:760-863-0471
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:SUITE #C
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-0138
Practice Address - Fax:760-863-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41070Medicare UPIN