Healthcare Provider Details

I. General information

NPI: 1013929157
Provider Name (Legal Business Name): YAHYA IBRAHIM ELSHIMALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JHON YAHYA IBRAHIM ELSHIMALI MD

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 HASKELL AVE SUITE # 302
VAN NUYS CA
91406-1900
US

IV. Provider business mailing address

7855 HASKELL AVE STE 302
VAN NUYS CA
91406-1902
US

V. Phone/Fax

Practice location:
  • Phone: 818-515-7618
  • Fax:
Mailing address:
  • Phone: 818-994-9714
  • Fax: 818-994-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberA55296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: