Provider Demographics
NPI:1245420199
Name:ISKANDER MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ISKANDER MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:YOUSSEF
Authorized Official - Last Name:ISKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-978-8026
Mailing Address - Street 1:4477 W 118TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2258
Mailing Address - Country:US
Mailing Address - Phone:310-978-8026
Mailing Address - Fax:310-978-1408
Practice Address - Street 1:4477 W 118TH ST STE 301
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2258
Practice Address - Country:US
Practice Address - Phone:310-978-8026
Practice Address - Fax:310-978-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A390110OtherBLUE SHIELD OF CALIFORNIA
CA00A390110OtherCCS
CA1679580880OtherINDIVIDUAL NPI NUMBER
CA00A390110OtherMEDI-CAL