Provider Demographics
NPI:1184605115
Name:MOHIUDDIN, SYED G (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:G
Last Name:MOHIUDDIN
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 1:483 N AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2808
Mailing Address - Country:US
Mailing Address - Phone:310-653-2873
Mailing Address - Fax:
Practice Address - Street 1:483 N AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2808
Practice Address - Country:US
Practice Address - Phone:310-653-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC177107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0984692OtherHEALTH PLUS
MI203824OtherHEALTH ADVANTAGE NETWORK
MI350D410030OtherCOMMUNITY BLUE
MI350D410030OtherBLUE CARE NETWORK
MI350D410030OtherBLUE CROSS POS
MAB44573OtherHEALTH ALLIANCE PLAN
MI4083182Medicaid
MI203824OtherMCLAREN HEALTH PLAN
MI370013059OtherMETRAHEALTH
MI4340778OtherAETNA
MIC6435OtherMCARE
MI350D410030OtherBLUE CROSS BLUE SHIELD
MIB44573OtherHEALTH NET FEDERAL SERV
MI0984692OtherHEALTH PLUS
MIB44573OtherHEALTH NET FEDERAL SERV
MIC6435OtherMCARE