Provider Demographics
NPI:1801039292
Name:KANU, ABDUL SADAT (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:SADAT
Last Name:KANU
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 1:10855 CHURCH ST APT 1312
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8581
Mailing Address - Country:US
Mailing Address - Phone:510-599-2835
Mailing Address - Fax:
Practice Address - Street 1:12830 HESPERIA RD STE C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7788
Practice Address - Country:US
Practice Address - Phone:760-684-8999
Practice Address - Fax:760-684-8111
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126557207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine