Provider Demographics
NPI:1093283905
Name:ALKHATIB, OUSAMA (MD)
Entity Type:Individual
Prefix:
First Name:OUSAMA
Middle Name:
Last Name:ALKHATIB
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:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:
Practice Address - Street 1:1010 W LA VETA AVE STE 570
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4305
Practice Address - Country:US
Practice Address - Phone:714-835-7700
Practice Address - Fax:714-835-8144
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC170837207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology