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NPI Code Detail

MEDICARE: EHAB YACOUB MD INC.

MEDICARE: EHAB YACOUB MD INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianA76244CA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1538581913
Entity Type Code : Organization
Provider Name (Legal Business Name) : EHAB YACOUB MD INC.
Provider Business Mailing Address
First Line : 14541 DELANO ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-2820
Country : US
Telephone Number : 310-515-8113
Fax Number : 310-538-2102
Provider Business Practice Location Address
First Line : 14541 DELANO ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-2820
Country : US
Telephone Number : 877-515-8113
Fax Number : 877-538-2102
Authorized Official
Title or Position : CEO
Name : EHAB S YACOUB
Credential : MD
Telephone Number : 310-592-4529
Provider Enumeration Date : 01/20/2014
Last Update Date : 01/30/2024

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