Provider Demographics
NPI:1780326124
Name:FADAAK, AHMED HUSSEIN
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:HUSSEIN
Last Name:FADAAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KING FAISAL IBN ABD AL AZIZ ROAD
Mailing Address - Street 2:
Mailing Address - City:DAMMAM
Mailing Address - State:EASTREN PROVINCE
Mailing Address - Zip Code:34212
Mailing Address - Country:SA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KING FAISAL IBN ABD AL AZIZ ROAD
Practice Address - Street 2:
Practice Address - City:DAMMAM
Practice Address - State:EASTERN PROVINCE
Practice Address - Zip Code:34212
Practice Address - Country:SA
Practice Address - Phone:613-333-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid
5874OtherHEALTH PARTNERS
568946544OtherBCBS