MEDICARE: MUHAMMAD J. MEMON PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1376873554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUHAMMAD J. MEMON PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	555 W COMPTON BLVD
Second Line	:	104
City	:	COMPTON
State	:	CA
Zip	:	90220-3085
Country	:	US
Telephone Number	:	310-639-7200
Fax Number	:	310-639-0200

Provider Business Practice Location Address
First Line	:	555 W COMPTON BLVD
Second Line	:	104
City	:	COMPTON
State	:	CA
Zip	:	90220-3085
Country	:	US
Telephone Number	:	310-639-7200
Fax Number	:	310-639-0200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUHAMMAD J MEMON
Credential	:	MD
Telephone Number	:	310-639-7200

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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