Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | A113977 | CA |
Y | 208200000X | Surgeon | A113977 | CA |
Y | 208600000X | Surgeon | A113977 | CA |
NPI | 1053432054 |
---|---|
Provider Name | Husam Elias |
First Address | Sherman Oaks, CA 91403-1715 |
Second Address | Sherman Oaks, CA 91403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 23/04/2013 |