Provider Demographics
NPI:1982715843
Name:HOSSAIN, KAMAL KALI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:KALI
Last Name:HOSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMAL
Other - Middle Name:RUBY KALI
Other - Last Name:HOSSAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:23080 ALESSANDRO BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9674
Mailing Address - Country:US
Mailing Address - Phone:951-697-7866
Mailing Address - Fax:951-697-7869
Practice Address - Street 1:23080 ALESSANDRO BLVD
Practice Address - Street 2:STE 202
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9674
Practice Address - Country:US
Practice Address - Phone:951-688-3001
Practice Address - Fax:951-688-3022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A406620Medicaid
CAC04000Medicare UPIN
CA00A406620Medicaid