Provider Demographics
NPI:1487831921
Name:MOHAMAD IQBALL RAJABALLY
Entity Type:Organization
Organization Name:MOHAMAD IQBALL RAJABALLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:IABALL
Authorized Official - Last Name:RAJABALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-657-5510
Mailing Address - Street 1:39675 CEDAR BLVD
Mailing Address - Street 2:ST 100
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560
Mailing Address - Country:US
Mailing Address - Phone:510-657-5510
Mailing Address - Fax:510-657-5587
Practice Address - Street 1:39675 CEDAR BLVD
Practice Address - Street 2:ST 100
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560
Practice Address - Country:US
Practice Address - Phone:510-657-5510
Practice Address - Fax:510-657-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36418-01OtherMEDI-CAL