Provider Demographics
NPI:1265970362
Name:LUNG SLEEP & MEDICINE INSTITUTE A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:LUNG SLEEP & MEDICINE INSTITUTE A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATHIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-841-8148
Mailing Address - Street 1:671 S MOLLISON AVE
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6682
Mailing Address - Country:US
Mailing Address - Phone:619-841-8148
Mailing Address - Fax:844-350-9978
Practice Address - Street 1:671 S MOLLISON AVE
Practice Address - Street 2:SUITE B & C
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6682
Practice Address - Country:US
Practice Address - Phone:619-841-8148
Practice Address - Fax:844-350-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116244207R00000X
CAC54733207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty