Provider Demographics
NPI:1306890827
Name:BILAL, BASSAM R (MD)
Entity type:Individual
Prefix:
First Name:BASSAM
Middle Name:R
Last Name:BILAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15642 SAND CANYON AVE UNIT 54102
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-5439
Mailing Address - Country:US
Mailing Address - Phone:949-344-5662
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:710 N EUCLID ST STE 400
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-517-2000
Practice Address - Fax:714-300-0473
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC150299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB294934Medicaid
OKH13586Medicare UPIN