Provider Demographics
NPI:1831464403
Name:HALA KOUDSI M.D., INC
Entity Type:Organization
Organization Name:HALA KOUDSI M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HALA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUDSI M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-378-8885
Mailing Address - Street 1:3655 LOMITA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:310-378-8885
Mailing Address - Fax:310-378-4248
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-378-8885
Practice Address - Fax:310-378-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38441207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty