Individual
ABDUL KEZIN HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 4TH ST, STE 200, SANTA ROSA, CA 95404-3601
(707) 579-2100
(707) 523-0616
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 523-0616
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A61120
CA
2086S0127X
Trauma Surgery Physician
A61120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A611200
BS OF CALIFORNIA
CA
05
—
1396859393
—
CA
01
—
P00469231
RR MEDICARE
CA
Enumeration date
08/18/2006
Last updated
02/07/2012
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