Provider Demographics
NPI:1538192166
Name:KADRI, MOHAMAD BACHIR (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:BACHIR
Last Name:KADRI
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 1:12351 GALE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3654
Mailing Address - Country:US
Mailing Address - Phone:310-978-0882
Mailing Address - Fax:818-957-3756
Practice Address - Street 1:1155 N VERMONT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1753
Practice Address - Country:US
Practice Address - Phone:323-912-9127
Practice Address - Fax:323-912-9128
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52479207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF88141Medicare UPIN