Provider Demographics
NPI:1831770437
Name:ABDEL-REHEEM, ABDUL-RAHMAN
Entity type:Individual
Prefix:
First Name:ABDUL-RAHMAN
Middle Name:
Last Name:ABDEL-REHEEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ABDUL
Other - Middle Name:
Other - Last Name:REHEEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLAZA
Mailing Address - Street 2:OTOLARYNGOLOGY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7419
Mailing Address - Country:US
Mailing Address - Phone:310-794-8492
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA
Practice Address - Street 2:OTOLARYNGOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7419
Practice Address - Country:US
Practice Address - Phone:310-794-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9485-851208600000X
CAA191285207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty