Provider Demographics
NPI:1023278504
Name:KASSAB, GHADA K (MD)
Entity type:Individual
Prefix:DR
First Name:GHADA
Middle Name:K
Last Name:KASSAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 MISSION BAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4921
Mailing Address - Country:US
Mailing Address - Phone:858-273-2726
Mailing Address - Fax:858-273-2725
Practice Address - Street 1:4606 MISSION BAY DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4921
Practice Address - Country:US
Practice Address - Phone:858-273-2726
Practice Address - Fax:858-273-2725
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114457207N00000X
IN11013338A207N00000X
IN01069398A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000720044OtherANTHEM PROVIDER NUMBER
IN201024080Medicaid
INM400051156Medicare PIN
IN201024080Medicaid
INP00974811Medicare PIN