Provider Demographics
NPI:1609295468
Name:AHMED, SARA HUSSAIN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HUSSAIN
Last Name:AHMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:SYED
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2581 ALISTER AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-0913
Mailing Address - Country:US
Mailing Address - Phone:909-456-9601
Mailing Address - Fax:
Practice Address - Street 1:1211 W LA PALMA AVE STE 702
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:714-533-0300
Practice Address - Fax:714-533-0700
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147669207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine