Provider Demographics
NPI:1265592174
Name:AUDEH, MOUNI WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:MOUNI
Middle Name:WILLIAM
Last Name:AUDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:C2000
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-1188
Mailing Address - Fax:310-423-4759
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:C2000
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-1188
Practice Address - Fax:310-423-4759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA40552207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A405520Medicaid
CA00A405520Medicaid
CAA40552Medicare ID - Type Unspecified