Provider Demographics
NPI:1891871620
Name:SABAH KADHIUM MD INC
Entity Type:Organization
Organization Name:SABAH KADHIUM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SABAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KADHIUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-596-4879
Mailing Address - Street 1:1334 W COVINA BLVD
Mailing Address - Street 2:204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3211
Mailing Address - Country:US
Mailing Address - Phone:909-599-6300
Mailing Address - Fax:909-305-2500
Practice Address - Street 1:1334 W COVINA BLVD
Practice Address - Street 2:204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:909-599-6300
Practice Address - Fax:909-305-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A5648800Medicaid
A56488Medicare PIN
G55456Medicare UPIN