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General NPI Number Information
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NPI Number | 1598070435
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Entity Type | Organization
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Legal Business Name | HUSSAM EL GOHARY MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 2001 DWIGHT WAY RM 2350
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-4738
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Fax | 510-204-5892
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Provider Business Mailing Address
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Address Line | 2342 SHATTUCK AVE #363
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City | BERKELEY
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State | CA
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Zip | 94704-1517
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Country | US
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Telephone | 510-964-0458
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Fax | 510-964-0476
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUSSAM IBRAHIM ELGOHARY
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Credential | M.D.
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Telephone | 510-964-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A37602
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License Number State | CA
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