Healthcare Provider Details

I. General information

NPI: 1265600795
Provider Name (Legal Business Name): EHAB NABIL HANNA MADY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUPERIOR AVE STE 250
NEWPORT BEACH CA
92663-2778
US

IV. Provider business mailing address

320 SUPERIOR AVE STE 250
NEWPORT BEACH CA
92663-2778
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-6002
  • Fax: 949-631-6982
Mailing address:
  • Phone: 949-631-6002
  • Fax: 949-631-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20A10166
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A10166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: