Provider Demographics
NPI:1306863956
Name:SHENOUDA, YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:
Last Name:SHENOUDA
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 1:3200 21ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3108
Mailing Address - Country:US
Mailing Address - Phone:661-334-1958
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72736207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727360Medicaid
CA00A727361Medicare PIN
CACD4582Medicare PIN
CAZZZ21367ZMedicare PIN
CAH70228Medicare UPIN
CA00A727362Medicare PIN
CAZZZ21366ZMedicare PIN
CAZZZ34009ZMedicare PIN
CA00A727363Medicare PIN
CA00A727364Medicare PIN
CAZZZ15999ZMedicare PIN
CA00A727360Medicaid
CA00A727365Medicare PIN
CA050089918Medicare PIN
CAZZZ21365ZMedicare PIN
CA00A727360Medicare PIN