Provider Demographics
NPI:1205847068
Name:GEWAID, SHENOUDA FATHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHENOUDA
Middle Name:FATHY
Last Name:GEWAID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W VERNON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2778
Mailing Address - Country:US
Mailing Address - Phone:323-233-5906
Mailing Address - Fax:323-232-7344
Practice Address - Street 1:231 W VERNON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2778
Practice Address - Country:US
Practice Address - Phone:323-233-5906
Practice Address - Fax:323-232-7344
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9325201Medicaid