Healthcare Provider Details

I. General information

NPI: 1932632700
Provider Name (Legal Business Name): ALSADIQ WALEED MOHAMMAD AL HILLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLAZA SUITE 700
LOS ANGELES CA
90095-3000
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-5400
  • Fax:
Mailing address:
  • Phone: 310-301-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA192915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: