Healthcare Provider Details

I. General information

NPI: 1629137583
Provider Name (Legal Business Name): EHAB A. MOHAMED MEDICAL CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD SUITE 414
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

9735 WILSHIRE BLVD SUITE 414
BEVERLY HILLS CA
90212-2107
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-5890
  • Fax: 310-276-5892
Mailing address:
  • Phone: 310-276-5890
  • Fax: 310-276-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA72575
License Number StateCA

VIII. Authorized Official

Name: DR. EHAB A MOHAMED
Title or Position: OWNER
Credential: M.D.
Phone: 310-276-5890