| Crescent Wound Care Inc | |
|
1310 W Granger Ave Modesto CA 95350-3911 | |
| (858) 936-7307 | |
| Not Available |
| Full Name | Crescent Wound Care Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1310 W Granger Ave, Modesto, California |
| Authorized Official Name and Position | Mohamed Kadry-hassanein (PRESIDENT) |
| Authorized Official Contact | 8589673070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crescent Wound Care Inc 5580 La Jolla Blvd # 622 La Jolla CA 92037-7651 Ph: (858) 936-7307 | Crescent Wound Care Inc 1310 W Granger Ave Modesto CA 95350-3911 Ph: (858) 936-7307 |
| NPI Number | 1841920501 |
|---|---|
| Provider Enumeration Date | 06/15/2022 |
| Last Update Date | 10/27/2024 |
| Medicare PECOS PAC ID | 3274914502 |
|---|---|
| Medicare Enrollment ID | O20220719000466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841920501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Karin M Dydell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710094107 PECOS PAC ID: 8224930805 Enrollment ID: I20040123000538 |
| Provider Name | Tuan A Doan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831200526 PECOS PAC ID: 9931184116 Enrollment ID: I20040622000518 |
| Provider Name | Edward K Chough |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316050289 PECOS PAC ID: 7214906239 Enrollment ID: I20040927001117 |
| Provider Name | Arudi L Prabhakar |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1396710075 PECOS PAC ID: 3274570437 Enrollment ID: I20050411000283 |
| Provider Name | Anisa M Yalom |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164679908 PECOS PAC ID: 5799956405 Enrollment ID: I20110928000620 |
| Provider Name | Faisal Amin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225328818 PECOS PAC ID: 9335364132 Enrollment ID: I20140711000880 |
| Provider Name | Mohamed K Hassanein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164794673 PECOS PAC ID: 3173812112 Enrollment ID: I20160516000949 |
| Provider Name | Rajiv Kumra |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1750581096 PECOS PAC ID: 1557450640 Enrollment ID: I20200520000602 |
| Provider Name | Najib M Allabadi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538692256 PECOS PAC ID: 5890114417 Enrollment ID: I20201001001229 |
| Provider Name | Andrea A Zaw |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1073994455 PECOS PAC ID: 8527359868 Enrollment ID: I20210708003129 |
| Provider Name | Oscar D Lazcano |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1811337306 PECOS PAC ID: 4587894555 Enrollment ID: I20210825002231 |
| Provider Name | Christopher Sung-bo Kim |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1588155477 PECOS PAC ID: 4284980475 Enrollment ID: I20211018002504 |
| Provider Name | Mohammad Yusuf Hanif |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851701296 PECOS PAC ID: 7618192881 Enrollment ID: I20220304000731 |
| Provider Name | Meghan M Kubala |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1770012684 PECOS PAC ID: 6507137163 Enrollment ID: I20220906001143 |
| Provider Name | Michael Zuckerman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003909235 PECOS PAC ID: 6103718630 Enrollment ID: I20231207001855 |
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