Provider Demographics
NPI:1497736938
Name:SHARIF, JABIR RAHMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JABIR
Middle Name:RAHMAN
Last Name:SHARIF
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 1:1131 VIA SEBASTIAN
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2310
Mailing Address - Country:US
Mailing Address - Phone:310-419-4616
Mailing Address - Fax:
Practice Address - Street 1:4632 W CENTURY BLVD
Practice Address - Street 2:STE A
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-1454
Practice Address - Country:US
Practice Address - Phone:310-419-4616
Practice Address - Fax:310-419-4756
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53277207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G532770Medicaid
CAG53277AMedicare PIN
CA00G532770Medicaid