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General NPI Number Information
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NPI Number | 1407806797
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Entity Type | Individual
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Provider Name | HEITHAM HASSOUN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 424-315-4508
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Fax | 310-423-0246
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Provider Business Mailing Address
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Address Line | PO BOX 512717
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City | LOS ANGELES
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State | CA
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Zip | 90051-0717
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Country | US
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Telephone | 424-315-4508
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | C160417
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | L0817
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D63527
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License Number State | MD
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