Healthcare Provider Details

I. General information

NPI: 1861612954
Provider Name (Legal Business Name): MD ABUL HASHEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 S VERMONT AVE STE 14
LOS ANGELES CA
90006-2764
US

IV. Provider business mailing address

1133 S VERMONT AVE STE 14
LOS ANGELES CA
90006-2764
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-6300
  • Fax: 213-487-2495
Mailing address:
  • Phone: 213-487-6300
  • Fax: 213-487-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: