Provider Demographics
NPI:1801909858
Name:FAHMY, MONA A (DDS)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:A
Last Name:FAHMY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2528
Mailing Address - Country:US
Mailing Address - Phone:714-739-2051
Mailing Address - Fax:714-739-5146
Practice Address - Street 1:8402 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2528
Practice Address - Country:US
Practice Address - Phone:714-739-2051
Practice Address - Fax:714-739-5146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine