Provider Demographics
NPI:1902945926
Name:VALLY-MAHOMED, ZAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZAIN
Middle Name:
Last Name:VALLY-MAHOMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14691 SERON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2129
Mailing Address - Country:US
Mailing Address - Phone:949-302-3636
Mailing Address - Fax:
Practice Address - Street 1:345 KAUILA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2107
Practice Address - Country:US
Practice Address - Phone:808-333-3544
Practice Address - Fax:808-333-3545
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107041207R00000X
HIMD-15396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine