Healthcare Provider Details

I. General information

NPI: 1073441689
Provider Name (Legal Business Name): EMAN ALLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10310 SANTA MONICA BLVD
LOS ANGELES CA
90025-7233
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-1196
  • Fax:
Mailing address:
  • Phone: 317-985-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberSP328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: