Provider Demographics
NPI:1609954171
Name:KAMALI, POURANG (MD)
Entity type:Individual
Prefix:DR
First Name:POURANG
Middle Name:
Last Name:KAMALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:KAMALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:769 MEDICAL CENTER CT STE 301
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6602
Mailing Address - Country:US
Mailing Address - Phone:619-271-2700
Mailing Address - Fax:619-737-9387
Practice Address - Street 1:769 MEDICAL CENTER CT.
Practice Address - Street 2:SUITE # 301
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6658
Practice Address - Country:US
Practice Address - Phone:619-754-6120
Practice Address - Fax:619-482-6656
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90859207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064490Medicaid