Healthcare Provider Details

I. General information

NPI: 1831770437
Provider Name (Legal Business Name): ABDUL-RAHMAN ABDEL-REHEEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ABDUL REHEEM

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLAZA OTOLARYNGOLOGY
LOS ANGELES CA
90095-7419
US

IV. Provider business mailing address

757 WESTWOOD PLAZA OTOLARYNGOLOGY
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-8492
  • Fax:
Mailing address:
  • Phone: 310-794-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA191285
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9485-851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: