Provider Demographics
NPI:1053393520
Name:DANDAN, MELHEM (MD)
Entity type:Individual
Prefix:DR
First Name:MELHEM
Middle Name:
Last Name:DANDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MELHEM
Other - Middle Name:ABD-ALLAH
Other - Last Name:DANDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:354 E SOUTHCROSS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-3595
Mailing Address - Country:US
Mailing Address - Phone:661-912-7458
Mailing Address - Fax:
Practice Address - Street 1:354 E SOUTHCROSS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-3595
Practice Address - Country:US
Practice Address - Phone:210-333-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0716207V00000X
CAA78213207Q00000X
TXA78213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114404OtherBOARD CERT #
CA00A782130OtherBLUE SHIELD OF CA PIN
CA00A782130Medicaid
CABD7037345OtherDEA CERT #
CA00A782130Medicaid
CA00A782130OtherBLUE SHIELD OF CA PIN
CABD7037345OtherDEA CERT #