Healthcare Provider Details

I. General information

NPI: 1821386491
Provider Name (Legal Business Name): SAMEH MOHAMED ELAMIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 11/09/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

PO BOX 2218
ANAHEIM CA
92814-0218
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-4983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME111081
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number56059
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC163235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: