Provider Demographics
NPI:1427063197
Name:WASSEF, EZZAT WADIH (MD)
Entity type:Individual
Prefix:MR
First Name:EZZAT
Middle Name:WADIH
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DOWNEY AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1482
Mailing Address - Country:US
Mailing Address - Phone:562-633-3787
Mailing Address - Fax:562-633-1977
Practice Address - Street 1:5750 DOWNEY AVE STE 308
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1482
Practice Address - Country:US
Practice Address - Phone:562-633-3787
Practice Address - Fax:562-633-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30443207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066890Medicaid
CAGR0066890Medicaid
WA30443CMedicare ID - Type Unspecified