Provider Demographics
NPI:1730105784
Name:ISMAIL, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ISMAIL
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 1:16415 COLORADO AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-602-2334
Mailing Address - Fax:562-602-0931
Practice Address - Street 1:16415 COLORADO AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:562-602-2334
Practice Address - Fax:562-602-0931
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45544207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455440Medicaid
W20647OtherMEDICARE
CA00A455440Medicaid