Provider Demographics
NPI:1952368409
Name:HUSSAIN, CORY KHURRAM (MD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:KHURRAM
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHURRAM
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:415-600-4900
Mailing Address - Fax:415-369-1365
Practice Address - Street 1:45 CASTRO ST STE 125
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1032
Practice Address - Country:US
Practice Address - Phone:415-600-4900
Practice Address - Fax:415-369-1365
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40764207R00000X
OH35123218207RI0200X
CAC145278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68951272Medicaid
OH0102440Medicaid
CAC145278OtherMEDICAL LICENSE
H32833Medicare UPIN
OH0102440Medicaid