Provider Demographics
NPI:1669517942
Name:DR. RAHIMA KASSAM P.A.
Entity type:Organization
Organization Name:DR. RAHIMA KASSAM P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-574-4255
Mailing Address - Street 1:PO BOX 630523
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0129
Mailing Address - Country:US
Mailing Address - Phone:214-574-4255
Mailing Address - Fax:214-351-4254
Practice Address - Street 1:3530 FOREST LN
Practice Address - Street 2:SUITE 245
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7910
Practice Address - Country:US
Practice Address - Phone:214-574-4255
Practice Address - Fax:214-351-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9893111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00008ZMedicare ID - Type UnspecifiedGROUP
TXV05257Medicare UPIN
TX8F0392Medicare PIN