Provider Demographics
NPI:1487099156
Name:ADVANCED ENT - HEAD & NECK SURGERY, PC.
Entity type:Organization
Organization Name:ADVANCED ENT - HEAD & NECK SURGERY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:310-433-4050
Mailing Address - Street 1:453 QUESTA CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4505
Mailing Address - Country:US
Mailing Address - Phone:661-262-9150
Mailing Address - Fax:888-959-4959
Practice Address - Street 1:38660 MEDICAL CENTER DR STE A200
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4385
Practice Address - Country:US
Practice Address - Phone:661-262-9150
Practice Address - Fax:888-959-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34819207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03933Medicare UPIN