Provider Demographics
NPI:1417900770
Name:MOHAMMAD, FAISAL ABDUL (MD)
Entity Type:Individual
Prefix:MR
First Name:FAISAL
Middle Name:ABDUL
Last Name:MOHAMMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:FAISAL
Other - Middle Name:ABDUL
Other - Last Name:MUHAMMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 84294
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5594
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:503-372-2754
Practice Address - Street 1:225 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1603
Practice Address - Country:US
Practice Address - Phone:408-259-5000
Practice Address - Fax:408-928-7041
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71594207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715940Medicaid
H24181Medicare UPIN
CA00A715940Medicaid