Provider Demographics
NPI:1801999800
Name:KATIBY, NAIM SAFIULLAH (MD)
Entity type:Individual
Prefix:DR
First Name:NAIM
Middle Name:SAFIULLAH
Last Name:KATIBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15921 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3005
Mailing Address - Country:US
Mailing Address - Phone:510-278-1123
Mailing Address - Fax:510-278-1267
Practice Address - Street 1:15921 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3005
Practice Address - Country:US
Practice Address - Phone:510-278-1123
Practice Address - Fax:510-278-1267
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A508260Medicare PIN
CAF23510Medicare UPIN
CA00A508261Medicare PIN