Provider Demographics
NPI:1013495431
Name:IMAM, KAMRAN HUSSAIN (MD)
Entity type:Individual
Prefix:
First Name:KAMRAN
Middle Name:HUSSAIN
Last Name:IMAM
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 1:8081 E SPRINGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1555
Mailing Address - Country:US
Mailing Address - Phone:909-342-4916
Mailing Address - Fax:
Practice Address - Street 1:3600 LIME ST STE 516
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-0944
Practice Address - Country:US
Practice Address - Phone:951-367-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173489207RG0300X, 207RA0201X, 207K00000X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology