Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | A94991 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A94991 | CA |
NPI | 1285715086 |
---|---|
Provider Name | Jeffrey Ashraf Hammoudeh |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 29/11/2017 |