Provider Demographics
NPI:1790965903
Name:MOHSEN M HAMZA MD INC
Entity Type:Organization
Organization Name:MOHSEN M HAMZA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-477-7201
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1785
Mailing Address - Country:US
Mailing Address - Phone:310-477-7201
Mailing Address - Fax:310-575-0973
Practice Address - Street 1:11600 WILSHIRE BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1785
Practice Address - Country:US
Practice Address - Phone:310-477-7201
Practice Address - Fax:310-575-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA435432084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43543OtherMEDICARE PTAN
CA1003996844OtherINDIVIDUAL NPI
CAA43543OtherMEDICARE PTAN
CAA43543OtherMEDICARE PTAN