=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164370938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRESCENT WOUND CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 112TH ST SW
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98204-3784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-513-1600
-----------------------------------------------------
Fax | 610-925-7895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5580 LA JOLLA BLVD STE 622
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-7651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-513-1600
-----------------------------------------------------
Fax | 610-925-7895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMED KADRY-HASSANEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 858-967-3070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------