Provider Demographics
NPI:1689744120
Name:MEMON, MUHAMMAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:J
Last Name:MEMON
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 1:555 W COMPTON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3099
Mailing Address - Country:US
Mailing Address - Phone:310-639-7200
Mailing Address - Fax:310-639-0200
Practice Address - Street 1:555 W COMPTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3099
Practice Address - Country:US
Practice Address - Phone:310-639-7200
Practice Address - Fax:310-639-0200
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB6816OtherUNIQ SUPPL ID
CA54220ZZZ03316ZOtherBLUE SHIELD ID
CA207Q00000XOtherTAXED ID
CAA66225OtherMEDICAL LIC
CA00A662250Medicaid
CA05D0893384OtherCLIA #
CA54220ZZZ03316ZOtherBLUE SHIELD ID
CA207Q00000XOtherTAXED ID