Provider Demographics
NPI:1407980410
Name:JABER, MOHAMMAD RAFFAT KH (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD RAFFAT
Middle Name:KH
Last Name:JABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8043 2ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3692
Mailing Address - Country:US
Mailing Address - Phone:562-862-1134
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:8043 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3692
Practice Address - Country:US
Practice Address - Phone:562-862-1134
Practice Address - Fax:562-861-9895
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN508842086S0129X
CAA919962086S0129X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I784815Medicare PIN