Provider Demographics
NPI:1720703325
Name:AWSS ZIDAN MD PC
Entity Type:Organization
Organization Name:AWSS ZIDAN MD PC
Other - Org Name:CAREND PROVIDER GROUP OF CALIFORNIA, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AWSS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-534-5527
Mailing Address - Street 1:2045 W GRAND AVE STE B
Mailing Address - Street 2:PMB 89496
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:708-872-7108
Mailing Address - Fax:
Practice Address - Street 1:548 MARKET ST # 47606
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5401
Practice Address - Country:US
Practice Address - Phone:708-872-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty