Provider Demographics
NPI:1376586644
Name:KALLAH, AFRAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:AFRAM
Middle Name:S
Last Name:KALLAH
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:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-1071
Mailing Address - Country:US
Mailing Address - Phone:714-647-4170
Mailing Address - Fax:888-959-3949
Practice Address - Street 1:550 N FLOWER ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2361
Practice Address - Country:US
Practice Address - Phone:714-647-4170
Practice Address - Fax:888-959-3949
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A693750Medicaid
CAH35975Medicare UPIN
CA00A693750Medicaid