Provider Demographics
NPI:1437231768
Name:NABAI, HOSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:NABAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:15609 HAYDEN LAKE PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3318
Mailing Address - Country:US
Mailing Address - Phone:619-229-0361
Mailing Address - Fax:619-287-2825
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:SUIT#205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4905
Practice Address - Country:US
Practice Address - Phone:619-229-0361
Practice Address - Fax:619-265-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46417Medicare PIN