Basic Information
Provider Information
NPI: 1003498528
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYED
FirstName: OMAIR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1411 E 31ST STREET
Address2: 2ND FLR A2
City: OAKLAND
State: CA
PostalCode: 94602
CountryCode: US
TelephoneNumber: 5104375039
FaxNumber:  
Practice Location
Address1: 1411 E 31ST STREET
Address2: 2ND FLR A2
City: OAKLAND
State: CA
PostalCode: 94602
CountryCode: US
TelephoneNumber: 5104375039
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/23/2021
LastUpdateDate: 04/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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