Provider Demographics
NPI:1104113976
Name:MAMDANI, SOHAIL (DO)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:
Last Name:MAMDANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3450
Mailing Address - Country:US
Mailing Address - Phone:209-826-5913
Mailing Address - Fax:209-826-2652
Practice Address - Street 1:808 IOWA AVE
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3450
Practice Address - Country:US
Practice Address - Phone:209-826-5913
Practice Address - Fax:209-826-2652
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272621208600000X
CAA14153208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A14153OtherCA
NY272621OtherLICENSE