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General NPI Number Information
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NPI Number | 1346400819
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Entity Type | Organization
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Legal Business Name | MAHMOUD AJANG M.D., A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 378 W 6TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3338
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Country | US
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Telephone | 310-547-1801
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Fax | 310-547-3015
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Provider Business Mailing Address
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Address Line | 3466 HIGHTIDE DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6131
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Country | US
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Telephone | 310-547-2882
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Fax | 310-547-3015
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHMOUD AJANG
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Credential | M.D.
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Telephone | 310-547-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A37717
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License Number State | CA
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