Provider Demographics
NPI:1801831904
Name:SIOUTY, HICHAM (MD)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:
Last Name:SIOUTY
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 1:23600 TELO AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-325-3084
Mailing Address - Fax:310-325-4938
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-325-3084
Practice Address - Fax:310-325-4938
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42582Medicare ID - Type Unspecified