Healthcare Provider Details

I. General information

NPI: 1659698181
Provider Name (Legal Business Name): MARK YOUSSEF A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 5TH ST STE 300
SANTA MONICA CA
90401-1433
US

IV. Provider business mailing address

1317 5TH ST STE 300
SANTA MONICA CA
90401-1433
US

V. Phone/Fax

Practice location:
  • Phone: 310-434-0044
  • Fax:
Mailing address:
  • Phone: 310-434-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA77473
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK YOUSSEF
Title or Position: DIRECT/ SOLE OWNER
Credential: MD
Phone: 818-888-7815