Provider Demographics
NPI:1306836770
Name:KADHIUM, SABAH (MD)
Entity Type:Individual
Prefix:MR
First Name:SABAH
Middle Name:
Last Name:KADHIUM
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 1:1334 W COVINA BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3211
Mailing Address - Country:US
Mailing Address - Phone:909-599-6300
Mailing Address - Fax:909-305-2500
Practice Address - Street 1:1334 W COVINA BLVD
Practice Address - Street 2:STE 204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:909-599-6300
Practice Address - Fax:909-305-2500
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A54880Medicaid
CA00A54880Medicaid
G55456Medicare UPIN