Provider Demographics
NPI:1699969287
Name:ALJOUDI, HAYTHAM (MD)
Entity type:Individual
Prefix:DR
First Name:HAYTHAM
Middle Name:
Last Name:ALJOUDI
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 1:1801 E MARCH LN STE D400
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6675
Mailing Address - Country:US
Mailing Address - Phone:209-464-3615
Mailing Address - Fax:304-691-8510
Practice Address - Street 1:1801 E MARCH LN STE D400
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6675
Practice Address - Country:US
Practice Address - Phone:209-464-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22763207R00000X, 207RC0000X
WAMD00047415207R00000X
CAC150276207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7376351Medicare PIN
P00819491Medicare PIN
AL4254412Medicare PIN