Provider Demographics
NPI:1164502365
Name:EL-GOHARY, HUSSAM I (MD)
Entity Type:Individual
Prefix:
First Name:HUSSAM
Middle Name:I
Last Name:EL-GOHARY
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 1:2001 DWIGHT WAY
Mailing Address - Street 2:2ND FLOOR - ROOM # 2350
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-204-4738
Mailing Address - Fax:510-204-5892
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:2ND FLOOR, ROOM # 2350
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4738
Practice Address - Fax:510-204-5892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37602208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation