Provider Demographics
NPI:1124154703
Name:ANJUM B QAZI M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANJUM B QAZI M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANJUM
Authorized Official - Middle Name:B
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-750-5359
Mailing Address - Street 1:2173 LOMITA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1636
Mailing Address - Country:US
Mailing Address - Phone:424-305-4169
Mailing Address - Fax:310-791-7409
Practice Address - Street 1:2173 LOMITA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1636
Practice Address - Country:US
Practice Address - Phone:424-305-4169
Practice Address - Fax:310-791-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49017Medicare UPIN
CAA88843Medicare ID - Type Unspecified