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General NPI Number Information
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NPI Number | 1053432054
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Entity Type | Individual
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Provider Name | HUSAM ELIAS MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 4910 VAN NUYS BLVD SUITE 102
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-789-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 4910 VAN NUYS BLVD SUITE 102
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1715
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Country | US
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Telephone | 818-789-6622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A113977
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A113977
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | A113977
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License Number State | CA
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