Provider Demographics
NPI:1144407008
Name:AMAL Y. ZAKY M.D., INC
Entity Type:Organization
Organization Name:AMAL Y. ZAKY M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHARGHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-587-1175
Mailing Address - Street 1:7648 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6046
Mailing Address - Country:US
Mailing Address - Phone:323-587-1175
Mailing Address - Fax:323-587-7358
Practice Address - Street 1:7648 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6046
Practice Address - Country:US
Practice Address - Phone:323-587-1175
Practice Address - Fax:323-587-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88458Medicare UPIN
CAW7865Medicare PIN