Provider Demographics
NPI:1194348656
Name:ABD ELMASEH, SHENODA YOUSEF AZMY
Entity type:Individual
Prefix:
First Name:SHENODA
Middle Name:YOUSEF AZMY
Last Name:ABD ELMASEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6472 WARNER AVE APT E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5158
Mailing Address - Country:US
Mailing Address - Phone:714-487-1151
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8018
Practice Address - Country:US
Practice Address - Phone:949-276-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine