Individual provider Active NPI

Anoulla Ghannam

  • Specialist
  • Oakland, CA
National Provider Identifier
1609264928
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
L8455 Issued in CA
Practice address
4331 Piedmont Ave
Oakland, CA 94611-4715
Phone
(650) 315-5421
NPI assigned
Jan 8, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X L8455 CA Primary

Addresses

Primary practice location

4331 Piedmont Ave
Oakland, CA 94611-4715

Mailing address

30 Ocean Grove Ave
Daly City, CA 94015-3734
Phone (650) 315-5421

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L8455CAMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1609264928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 OCEAN GROVE AVE",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940153734",
            "telephone_number": "650-315-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4331 PIEDMONT AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946114715",
            "telephone_number": "650-315-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNAM",
        "first_name": "ANOULLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "L8455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.