Provider Demographics
NPI:1003996844
Name:HAMZA, MOHSEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:M
Last Name:HAMZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5781
Mailing Address - Country:US
Mailing Address - Phone:310-477-7201
Mailing Address - Fax:
Practice Address - Street 1:11600 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5781
Practice Address - Country:US
Practice Address - Phone:310-477-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA435432084N0400X, 261QH0100X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790965903OtherMEDICARE NPI
CA95-4286830OtherTAX ID
CA1790965903OtherMEDICARE NPI
CA1790965903OtherMEDICARE NPI