Provider Demographics
NPI:1770019069
Name:HUSEIN, HUSEIN (MD)
Entity type:Individual
Prefix:
First Name:HUSEIN
Middle Name:
Last Name:HUSEIN
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:600 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4201
Practice Address - Country:US
Practice Address - Phone:209-550-7455
Practice Address - Fax:510-491-7522
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67614208D00000X
IAMD-47261208D00000X, 2085N0904X, 207U00000X
CAA2013042085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine