Healthcare Provider Details

I. General information

NPI: 1265592174
Provider Name (Legal Business Name): MOUNI WILLIAM AUDEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD C2000
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8700 BEVERLY BLVD C2000
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1188
  • Fax: 310-423-4759
Mailing address:
  • Phone: 310-423-1188
  • Fax: 310-423-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA40552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: