Provider Demographics
NPI:1225200637
Name:YOUSSEF, MARK MAGDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MAGDY
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-7001
Mailing Address - Country:US
Mailing Address - Phone:818-888-7815
Mailing Address - Fax:818-715-1722
Practice Address - Street 1:1551 OCEAN AVE
Practice Address - Street 2:STE.#200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2108
Practice Address - Country:US
Practice Address - Phone:310-434-0044
Practice Address - Fax:310-434-0099
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77473207V00000X, 208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery