Provider Demographics
NPI:1467730390
Name:YAACOUB, RAMY FADY YOUSSEF (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMY
Middle Name:FADY YOUSSEF
Last Name:YAACOUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 CITY BLVD W STE 2100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2949
Mailing Address - Country:US
Mailing Address - Phone:714-456-7232
Mailing Address - Fax:888-378-4358
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6054
Practice Address - Fax:888-378-5391
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAF304208800000X
NC2012-01331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01391365OtherRR MEDICARE
CAP01391365OtherRR MEDICARE