Healthcare Provider Details

I. General information

NPI: 1801043286
Provider Name (Legal Business Name): SAMEH GHATTAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 03/07/2023
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

1680 E 120TH ST
LOS ANGELES CA
90059-3026
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA114099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA114099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: