Individual provider Active NPI

Vajeeha Tabassum, M.D

  • Hematology & Oncology Physician
  • Fresno, CA
National Provider Identifier
1699951582
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A145442 Issued in CA
Practice address
2335 E Kashian LN
Suite 301
Fresno, CA 93701-2230
Phone
(559) 256-9680
Fax
(559) 256-9681
NPI assigned
Jan 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-126602 IL
Hematology & Oncology Physician 207RH0003X A145442 CA Primary

Addresses

Primary practice location

2335 E Kashian LN
Suite 301
Fresno, CA 93701-2230

Mailing address

2625 E Divisadero St
Fresno, CA 93721-1431

Other identifiers 1

IdentifierTypeStateIssuer
036126602MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161129002343 CA Practitioner - Internal Medicine 4981749793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000

28150 Keller Rd
Murrieta, CA 92563-2432
Phone (877) 608-0044

75036 Gerald Ford Dr
Palm Desert, CA 92211-2080
Phone (866) 883-0119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A145442CAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 11, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 11, 2018 Accepting new patients
Community Foundation Medical Group Internal Medicine CurrentSince Nov 1, 2016 Accepting new patients
Community Foundation Medical Group CurrentSince Nov 1, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

2335 E Kashian Ln
Ste 230
Fresno, CA 93701
Phone (559) 321-2800

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

2625 E Divisadero St
Fresno, CA 93721
Phone (559) 453-5200

2335 E Kashian Ln
Ste 301
Fresno, CA 93701
Phone (559) 224-5864

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1699951582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 E KASHIAN LN",
            "address_2": "SUITE 301",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012230",
            "telephone_number": "559-256-9680",
            "fax_number": "559-256-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABASSUM",
        "first_name": "VAJEEHA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-10",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-126602",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A145442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036126602",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.