Healthcare Provider Details

I. General information

NPI: 1689598591
Provider Name (Legal Business Name): MFIDAI MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

IV. Provider business mailing address

2200 PACIFIC COAST HWY STE 215
HERMOSA BEACH CA
90254-2701
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-5116
  • Fax:
Mailing address:
  • Phone: 310-896-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHSIN FIDAI
Title or Position: CEO
Credential: MD
Phone: 847-809-5736