Provider Demographics
NPI:1598270191
Name:SAMEH SHENOUDA MD INC.
Entity Type:Organization
Organization Name:SAMEH SHENOUDA MD INC.
Other - Org Name:EMMANUEL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHENOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-988-9818
Mailing Address - Street 1:7963 VAN NUYS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6071
Mailing Address - Country:US
Mailing Address - Phone:818-983-7570
Mailing Address - Fax:
Practice Address - Street 1:7963 VAN NUYS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6071
Practice Address - Country:US
Practice Address - Phone:818-988-9818
Practice Address - Fax:818-988-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123234207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty