Provider Demographics
NPI:1356445522
Name:AL-AHMAD, LAMIS (MD)
Entity type:Individual
Prefix:
First Name:LAMIS
Middle Name:
Last Name:AL-AHMAD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3628
Mailing Address - Country:US
Mailing Address - Phone:949-599-2434
Mailing Address - Fax:949-599-2430
Practice Address - Street 1:1860 N WESTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3491
Practice Address - Country:US
Practice Address - Phone:323-825-9223
Practice Address - Fax:323-978-4883
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2025-02-20
Deactivation Date:2025-01-23
Deactivation Code:
Reactivation Date:2025-02-10
Provider Licenses
StateLicense IDTaxonomies
MI4301062743208000000X
CAC152422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E009340OtherBCBSM/BCN
MI3281943Medicaid
MI080E009340OtherBCBSM/BCN
G24722Medicare UPIN