Provider Demographics
NPI:1962486282
Name:HICHAM SIOUTY MD INC
Entity Type:Organization
Organization Name:HICHAM SIOUTY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIOUTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-325-3084
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85810Medicare UPIN
CAA42582Medicare ID - Type Unspecified