Provider Demographics
NPI:1215066881
Name:HAMRANG, KAMBIZ (MD)
Entity type:Individual
Prefix:
First Name:KAMBIZ
Middle Name:
Last Name:HAMRANG
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 1800
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1800
Mailing Address - Country:US
Mailing Address - Phone:858-459-1800
Mailing Address - Fax:858-459-0045
Practice Address - Street 1:3490 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1664
Practice Address - Country:US
Practice Address - Phone:858-429-1800
Practice Address - Fax:858-459-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA42928207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429281Medicaid
CAA42928Medicare ID - Type Unspecified
CA00A429281Medicaid