Provider Demographics
NPI:1932151867
Name:HADDAD, THOMAS KHOURI (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KHOURI
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:KHOURI
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:91 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2601
Mailing Address - Country:US
Mailing Address - Phone:646-831-3160
Mailing Address - Fax:
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-771-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA953521207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0593636OtherCLIA
CAGR0076920Medicaid
CALAB93636FOtherMEDICAL CLIA
CAGR0076920Medicaid