Provider Demographics
NPI:1760481915
Name:SEBAI, MOHAMED BASSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:BASSAM
Last Name:SEBAI
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 1:1238 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4951
Mailing Address - Country:US
Mailing Address - Phone:909-982-0099
Mailing Address - Fax:909-931-0402
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-982-0099
Practice Address - Fax:909-931-0402
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091870Medicaid
CAGR0091870Medicaid
CAZZZ00883ZMedicare ID - Type Unspecified