MEDICARE: SAMEH SHENOUDA MD INC.

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	207QA0505X	Adult Medicine Physician	A123234	CA

General Provider Information

NPI Number	:	1598270191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMEH SHENOUDA MD INC.

Provider Business Mailing Address
First Line	:	7963 VAN NUYS BLVD STE 101
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-6071
Country	:	US
Telephone Number	:	818-983-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	7963 VAN NUYS BLVD STE 101
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-6071
Country	:	US
Telephone Number	:	818-988-9818
Fax Number	:	818-988-9828

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SAMEH S SHENOUDA
Credential	:	MD
Telephone Number	:	818-988-9818

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	07/09/2020

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