Provider Demographics
NPI:1659315729
Name:AHMED, KABIR (MD)
Entity Type:Individual
Prefix:DR
First Name:KABIR
Middle Name:
Last Name:AHMED
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 1:20124 SAN VICENTE CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1843
Mailing Address - Country:US
Mailing Address - Phone:626-589-8935
Mailing Address - Fax:866-880-2840
Practice Address - Street 1:18300 US HIGHWAY 18
Practice Address - Street 2:ST MARY MEDICAL CENTER
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2206
Practice Address - Country:US
Practice Address - Phone:760-242-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69357207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050089049OtherRAILROAD MEDICARE
CA00A693570OtherBLUE SHIELD
CA00A693570328OtherCALOPTIMA
CA00A693570Medicaid
CA00A693570OtherBLUE SHIELD
H05361Medicare UPIN