MEDICARE: NOALAB MEDICAL CLINIC 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	208D00000X	General Practice Physician	A30092	CA

General Provider Information

NPI Number	:	1619226347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOALAB MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	6428 COLDWATER CANYON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1113
Country	:	US
Telephone Number	:	818-308-6440
Fax Number	:	818-308-6351

Provider Business Practice Location Address
First Line	:	6428 COLDWATER CANYON AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1113
Country	:	US
Telephone Number	:	818-308-6440
Fax Number	:	818-308-6351

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JIHAD S AL-IMAMI
Credential	:	M.D.
Telephone Number	:	818-308-6440

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	09/10/2012

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