Provider Demographics
NPI:1386654010
Name:KAISEY, MUSHRIK (MD)
Entity Type:Individual
Prefix:
First Name:MUSHRIK
Middle Name:
Last Name:KAISEY
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 1:340 4TH AVE
Mailing Address - Street 2:#9
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-426-9731
Mailing Address - Fax:619-427-9733
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:#9
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-426-9731
Practice Address - Fax:619-427-9733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72963207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729631Medicaid
CAA72963Medicare PIN
CAH09220Medicare UPIN