Healthcare Provider Details

I. General information

NPI: 1720089147
Provider Name (Legal Business Name): MOHAMAD J YAGHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S FIGUEROA ST , # F
LOS ANGELES CA
90037-2671
US

IV. Provider business mailing address

4301 S FIGUEROA ST STE F
LOS ANGELES CA
90037-2671
US

V. Phone/Fax

Practice location:
  • Phone: 323-231-7700
  • Fax: 323-231-0799
Mailing address:
  • Phone: 323-231-7700
  • Fax: 323-231-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: