Provider Demographics
NPI:1356367809
Name:KABBESH, MOHAMMAD JABER (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD JABER
Middle Name:
Last Name:KABBESH
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-861-1486
Mailing Address - Fax:
Practice Address - Street 1:3939 J ST STE 320
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3666
Practice Address - Country:US
Practice Address - Phone:916-733-5995
Practice Address - Fax:916-281-3862
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54090207R00000X, 207RI0200X
IA37101207R00000X, 207RG0300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48004OtherBLUE CROSS
IA1356367809Medicaid
FL271097800Medicaid
CAC54090OtherMEDICAL STATE LICENSE
IA1356367809Medicaid
FL271097800Medicaid
CADH649ZMedicare PIN