Provider Demographics
NPI:1528097730
Name:AL-SADEK, AHMED FEKRY (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:FEKRY
Last Name:AL-SADEK
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 8349
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8349
Mailing Address - Country:US
Mailing Address - Phone:805-773-6811
Mailing Address - Fax:
Practice Address - Street 1:17050 BUSHARD ST
Practice Address - Street 2:STE 205
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2832
Practice Address - Country:US
Practice Address - Phone:310-692-0224
Practice Address - Fax:714-368-3381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A930040Medicaid
CAI49102Medicare UPIN
CAWA93004AMedicare PIN
CAWA93004BMedicare PIN