Provider Demographics
NPI:1609840479
Name:FAIDI, ANAN ADNAN (MD)
Entity Type:Individual
Prefix:
First Name:ANAN
Middle Name:ADNAN
Last Name:FAIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1312
Mailing Address - Country:US
Mailing Address - Phone:209-948-3000
Mailing Address - Fax:209-948-3127
Practice Address - Street 1:930 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1312
Practice Address - Country:US
Practice Address - Phone:209-948-3000
Practice Address - Fax:209-948-3127
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48562207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485620Medicaid
00A485620Medicare ID - Type Unspecified
F22319Medicare UPIN