Basic Information
| Provider Information | |||||||||
| NPI: | 1003296096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAZEM | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | NAWEED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4080 CENTRE ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583427595 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4080 CENTRE ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583427595 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 03/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 33300 | CA | Y | Chiropractic Providers | Chiropractor |
No ID Information.