Provider Demographics
NPI:1629137583
Name:EHAB A. MOHAMED MEDICAL CORPORATION, INC.
Entity Type:Organization
Organization Name:EHAB A. MOHAMED MEDICAL CORPORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-276-5890
Mailing Address - Street 1:9735 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2107
Mailing Address - Country:US
Mailing Address - Phone:310-276-5890
Mailing Address - Fax:310-276-5892
Practice Address - Street 1:9735 WILSHIRE BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2107
Practice Address - Country:US
Practice Address - Phone:310-276-5890
Practice Address - Fax:310-276-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29139ZMedicare ID - Type UnspecifiedPROVIDER NUMBER