Healthcare Provider Details

I. General information

NPI: 1558397331
Provider Name (Legal Business Name): MEDHAT FOUAD MIKHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 BRISTOL ST STE 110
COSTA MESA CA
92626-7972
US

IV. Provider business mailing address

2549 EASTBLUFF DR # 313
NEWPORT BEACH CA
92660-3500
US

V. Phone/Fax

Practice location:
  • Phone: 714-252-7490
  • Fax: 714-203-8380
Mailing address:
  • Phone: 714-252-7490
  • Fax: 714-203-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA55997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: