Provider Demographics
NPI:1780024356
Name:PROFESSIONAL TRANSPORT, INC
Entity Type:Organization
Organization Name:PROFESSIONAL TRANSPORT, INC
Other - Org Name:KAAJ MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:HABEEB
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-937-9000
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1592
Mailing Address - Country:US
Mailing Address - Phone:408-937-9000
Mailing Address - Fax:408-937-9002
Practice Address - Street 1:2016 FOREST AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4804
Practice Address - Country:US
Practice Address - Phone:408-937-9000
Practice Address - Fax:408-937-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770593105Medicaid
CA1770593105Medicaid
CAZZZ03306ZMedicare PIN