Healthcare Provider Details

I. General information

NPI: 1578477345
Provider Name (Legal Business Name): PERENNE HEALTH WEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 REEVES ST
LOS ANGELES CA
90035-2928
US

IV. Provider business mailing address

1511 REEVES ST
LOS ANGELES CA
90035-2928
US

V. Phone/Fax

Practice location:
  • Phone: 310-598-0466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KHALED ELGHONEMY
Title or Position: PRESIDENT
Credential: MD
Phone: 310-598-0466