Provider Demographics
NPI:1780647313
Name:HABIB, MD MOKSEDUL (MD)
Entity Type:Individual
Prefix:
First Name:MD MOKSEDUL
Middle Name:
Last Name:HABIB
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 1:5945 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0610
Mailing Address - Country:US
Mailing Address - Phone:661-323-4278
Mailing Address - Fax:661-631-5546
Practice Address - Street 1:5945 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0610
Practice Address - Country:US
Practice Address - Phone:661-323-4278
Practice Address - Fax:661-631-5546
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17847Medicare UPIN
CA00A640691Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER