Provider Demographics
NPI:1477886794
Name:S. A. KASSAMALI MD INC
Entity Type:Organization
Organization Name:S. A. KASSAMALI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTANALI
Authorized Official - Middle Name:AMIRALI
Authorized Official - Last Name:KASSAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-755-2970
Mailing Address - Street 1:13561 GINGER GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6913
Mailing Address - Country:US
Mailing Address - Phone:858-755-2970
Mailing Address - Fax:
Practice Address - Street 1:13561 GINGER GLEN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6913
Practice Address - Country:US
Practice Address - Phone:858-755-2970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA032525261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A325250Medicaid
CAA26832Medicare UPIN