Provider Demographics
NPI:1083441331
Name:HUSSEIN, ISAM SUDEEK
Entity type:Individual
Prefix:
First Name:ISAM
Middle Name:SUDEEK
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 CAMPUS DR APT 320
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4929
Mailing Address - Country:US
Mailing Address - Phone:650-355-8080
Mailing Address - Fax:
Practice Address - Street 1:860 CAMPUS DR APT 320
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4929
Practice Address - Country:US
Practice Address - Phone:650-355-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No344600000XTransportation ServicesTaxi