Healthcare Provider Details

I. General information

NPI: 1568922508
Provider Name (Legal Business Name): LAITH A MUKDAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26726 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691-8003
US

IV. Provider business mailing address

26726 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691-8003
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-4361
  • Fax: 949-364-4495
Mailing address:
  • Phone: 949-364-4361
  • Fax: 949-364-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA182262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: