Provider Demographics
NPI:1699931097
Name:WAHIDI, QAIS MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:QAIS
Middle Name:MOHAMMAD
Last Name:WAHIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 CREEKSIDE DR
Mailing Address - Street 2:STE 2100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3447
Mailing Address - Country:US
Mailing Address - Phone:916-542-7467
Mailing Address - Fax:916-932-4879
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:STE 2100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3447
Practice Address - Country:US
Practice Address - Phone:916-542-7467
Practice Address - Fax:916-932-4879
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2020-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA111390207R00000X
CA111390261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty