Provider Demographics
NPI:1598329658
Name:MOHIDEEN, MUNEEB (MD)
Entity Type:Individual
Prefix:
First Name:MUNEEB
Middle Name:
Last Name:MOHIDEEN
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 1:10969 WELLWORTH AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6240
Mailing Address - Country:US
Mailing Address - Phone:219-510-2389
Mailing Address - Fax:
Practice Address - Street 1:1100 N. STATE STREET
Practice Address - Street 2:CLINIC TOWER A7D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program