Healthcare Provider Details

I. General information

NPI: 1427063197
Provider Name (Legal Business Name): EZZAT WADIH WASSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 DOWNEY AVE STE 308
LAKEWOOD CA
90712-1482
US

IV. Provider business mailing address

5750 DOWNEY AVE STE 308
LAKEWOOD CA
90712-1482
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-3787
  • Fax: 562-633-1977
Mailing address:
  • Phone: 562-633-3787
  • Fax: 562-633-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA30443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: