Provider Demographics
NPI:1083787907
Name:HOSSAIN, SYED M (MD )
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:HOSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.M
Other - Middle Name:GOLAM
Other - Last Name:HOSSAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1711 W TEMPLE ST STE 5658
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-484-5250
Mailing Address - Fax:213-263-2120
Practice Address - Street 1:1410 W ALONDRA BLVD STE B
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3533
Practice Address - Country:US
Practice Address - Phone:310-933-8755
Practice Address - Fax:310-933-8738
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA77221OtherCA LICENSE NUMBER