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General NPI Number Information
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NPI Number | 1396657730
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Entity Type | Organization
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Legal Business Name | FIRST CARE VANGUARD MEDICAL CLINIC
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 22406-22408 NORWALK BLVD
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716
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Country | US
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Telephone | 562-526-8014
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Fax | 562-526-8012
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Provider Business Mailing Address
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Address Line | 22406-22408 NORWALK BLVD
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716
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Country | US
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Telephone | 562-526-8014
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Fax | 562-526-8012
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. GHASSAN KHAMISEH
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Credential | M.D.
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Telephone | 562-526-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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