Provider Demographics
NPI:1538211347
Name:CANOUN, KARIM (MD)
Entity type:Individual
Prefix:
First Name:KARIM
Middle Name:
Last Name:CANOUN
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 1:401 AVILA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1168
Mailing Address - Country:US
Mailing Address - Phone:415-310-5705
Mailing Address - Fax:
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4945
Practice Address - Country:US
Practice Address - Phone:925-324-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72912208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G729120Medicaid
CA00G729120Medicaid
00G729120Medicare ID - Type Unspecified