Healthcare Provider Details

I. General information

NPI: 1851210322
Provider Name (Legal Business Name): FADI YOUSEF MALKIEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 MAGNOLIA BLVD
NORTH HOLLYWOOD CA
91601-3903
US

IV. Provider business mailing address

3150 WILSHIRE BLVD APT 1223
LOS ANGELES CA
90010-1382
US

V. Phone/Fax

Practice location:
  • Phone: 813-766-9667
  • Fax:
Mailing address:
  • Phone: 813-766-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: