Provider Demographics
NPI:1184980591
Name:QIDWAI, KANWAL (MD)
Entity type:Individual
Prefix:
First Name:KANWAL
Middle Name:
Last Name:QIDWAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 BARNDANCE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3523
Mailing Address - Country:US
Mailing Address - Phone:713-449-3536
Mailing Address - Fax:
Practice Address - Street 1:700 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2608
Practice Address - Country:US
Practice Address - Phone:713-449-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1337542083A0300X
CACA2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine