Provider Demographics
NPI:1457655771
Name:ADVANCED HEALTH CARE OF BAKERSFIELD INC
Entity Type:Organization
Organization Name:ADVANCED HEALTH CARE OF BAKERSFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YAKDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:AL QAISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-363-6800
Mailing Address - Street 1:4040 SAN DIMAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1298
Mailing Address - Country:US
Mailing Address - Phone:661-363-6800
Mailing Address - Fax:661-363-6888
Practice Address - Street 1:4040 SAN DIMAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1298
Practice Address - Country:US
Practice Address - Phone:661-363-6800
Practice Address - Fax:661-363-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6684900001OtherMEDICARE PTAN
CA6684900001Medicare NSC