Provider Demographics
NPI:1720211790
Name:DAWA ADVANCED MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:DAWA ADVANCED MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-295-1595
Mailing Address - Street 1:182 GOUGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5918
Mailing Address - Country:US
Mailing Address - Phone:415-558-8970
Mailing Address - Fax:415-358-4878
Practice Address - Street 1:182 GOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5918
Practice Address - Country:US
Practice Address - Phone:415-295-1595
Practice Address - Fax:415-358-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty