Basic Information
| Provider Information | |||||||||
| NPI: | 1548901374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KABAFUSION MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17777 CENTER COURT DR N STE 550 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004353020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8989 HERRMANN DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004353020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | MASOOD | ||||||||
| AuthorizedOfficialFirstName: | SOHAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8004353020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHARM. D. | ||||||||
| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
No ID Information.