Provider Demographics
NPI:1770513061
Name:CHOUDRY, QASIM MASUD (MD)
Entity type:Individual
Prefix:
First Name:QASIM
Middle Name:MASUD
Last Name:CHOUDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:631 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4402
Practice Address - Country:US
Practice Address - Phone:760-294-1660
Practice Address - Fax:760-745-5016
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38846207RN0300X, 2085R0204X
IN01062289A207RN0300X
CAA69038207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3696643000OtherPASSPORT ADVANTAGE
KYP00664725OtherPALMETTO GBA
INP00856204OtherPALMETTO GBA
IN200933180AMedicaid
KY50022543OtherPASSPORT
KY7100066630Medicaid
CAA69038OtherNEPHROLOGY
KY7100066630Medicaid
KY50022543OtherPASSPORT