Healthcare Provider Details

I. General information

NPI: 1003128372
Provider Name (Legal Business Name): RAYAN ABDO ELKATTAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BOULEVARD SUITE 207
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

9001 WILSHIRE BOULEVARD SUITE 207
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 423-930-0240
  • Fax: 310-551-7115
Mailing address:
  • Phone: 423-930-0240
  • Fax: 310-551-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC193339
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number51034
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: