Provider Demographics
NPI:1669461604
Name:YAMMINE, KAISAR ZEHRAN (PA C)
Entity Type:Individual
Prefix:
First Name:KAISAR
Middle Name:ZEHRAN
Last Name:YAMMINE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210907
Mailing Address - Street 2:KANER MEDICAL GROUP
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-7907
Mailing Address - Country:US
Mailing Address - Phone:817-358-5800
Mailing Address - Fax:817-283-5381
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:STE 220
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-358-5800
Practice Address - Fax:817-283-5381
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70966Medicare UPIN
TX84P421Medicare ID - Type Unspecified