Provider Demographics
NPI:1477019669
Name:PEDIATRIC CARDIAC CENTER INC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIAC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHWAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-933-2736
Mailing Address - Street 1:433 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4113
Mailing Address - Country:US
Mailing Address - Phone:530-933-2736
Mailing Address - Fax:
Practice Address - Street 1:433 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4113
Practice Address - Country:US
Practice Address - Phone:530-933-2736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty