Healthcare Provider Details

I. General information

NPI: 1730105784
Provider Name (Legal Business Name): MOHAMMAD ISMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE SUITE 207
PARAMOUNT CA
90723-5035
US

IV. Provider business mailing address

16415 COLORADO AVE SUITE 207
PARAMOUNT CA
90723-5035
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-2334
  • Fax: 562-602-0931
Mailing address:
  • Phone: 562-602-2334
  • Fax: 562-602-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA45544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: