Healthcare Provider Details

I. General information

NPI: 1679587091
Provider Name (Legal Business Name): DEAN FERDOWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAJDEDIN FERDOWS M.D.

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 SLAUSON AVE
MAYWOOD CA
90270-2838
US

IV. Provider business mailing address

PO BOX 412
PACIFIC PALISADES CA
90272-0412
US

V. Phone/Fax

Practice location:
  • Phone: 323-773-2020
  • Fax: 323-771-6069
Mailing address:
  • Phone: 323-773-2020
  • Fax: 323-771-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA46360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: