Provider Demographics
NPI:1346244050
Name:DAMEN, AYMAN (MD)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:DAMEN
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 1:150 N LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1721
Mailing Address - Country:US
Mailing Address - Phone:209-745-4633
Mailing Address - Fax:209-745-4637
Practice Address - Street 1:150 N LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1721
Practice Address - Country:US
Practice Address - Phone:209-745-4633
Practice Address - Fax:209-745-4637
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE39750Medicare UPIN