Healthcare Provider Details

I. General information

NPI: 1396657730
Provider Name (Legal Business Name): FIRST CARE VANGUARD MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22406-22408 NORWALK BLVD
HAWAIIAN GARDENS CA
90716
US

IV. Provider business mailing address

22406-22408 NORWALK BLVD
HAWAIIAN GARDENS CA
90716
US

V. Phone/Fax

Practice location:
  • Phone: 562-526-8014
  • Fax: 562-526-8012
Mailing address:
  • Phone: 562-526-8014
  • Fax: 562-526-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GHASSAN KHAMISEH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-526-8014