Provider Demographics
NPI:1679678718
Name:ZAKI, ADEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:EDWARD
Last Name:ZAKI
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 1:1233 N VERMONT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1749
Mailing Address - Country:US
Mailing Address - Phone:323-660-2090
Mailing Address - Fax:323-953-9549
Practice Address - Street 1:1233 N VERMONT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1749
Practice Address - Country:US
Practice Address - Phone:323-660-2090
Practice Address - Fax:323-953-9549
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24061208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A240610Medicaid
CA00A240610OtherBLUE SHIELD PROVIDER #
CAA24061OtherMEDICAL LICENSE #
CA00A240610OtherBLUE SHIELD PROVIDER #
CAA24061OtherMEDICAL LICENSE #