Provider Demographics
NPI:1750608931
Name:POURANG KAMALI MD INC
Entity type:Organization
Organization Name:POURANG KAMALI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-850-4161
Mailing Address - Street 1:752 MEDICAL CENTER CT
Mailing Address - Street 2:106
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6658
Mailing Address - Country:US
Mailing Address - Phone:619-754-6120
Mailing Address - Fax:619-482-6656
Practice Address - Street 1:752 MEDICAL CENTER CT
Practice Address - Street 2:106
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6658
Practice Address - Country:US
Practice Address - Phone:619-754-6120
Practice Address - Fax:619-482-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90859261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center