Healthcare Provider Details

I. General information

NPI: 1164502365
Provider Name (Legal Business Name): HUSSAM I EL-GOHARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY 2ND FLOOR, ROOM # 2350
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY 2ND FLOOR - ROOM # 2350
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4738
  • Fax: 510-204-5892
Mailing address:
  • Phone: 510-204-4738
  • Fax: 510-204-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA37602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: