Provider Demographics
NPI:1922182682
Name:AJANG, MAHMOUD (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:
Last Name:AJANG
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 1:3466 HIGHTIDE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275
Mailing Address - Country:US
Mailing Address - Phone:310-547-2882
Mailing Address - Fax:310-547-3015
Practice Address - Street 1:378 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731
Practice Address - Country:US
Practice Address - Phone:310-547-2882
Practice Address - Fax:310-547-3015
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA377172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377170Medicaid
CA00A377170Medicaid
CAA37717Medicare ID - Type Unspecified