Provider Demographics
NPI:1538344437
Name:EMILE G. SHENOUDA MD INC.
Entity type:Organization
Organization Name:EMILE G. SHENOUDA MD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SHENOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-566-4411
Mailing Address - Street 1:10132 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6008
Mailing Address - Country:US
Mailing Address - Phone:323-566-4411
Mailing Address - Fax:323-566-0390
Practice Address - Street 1:10132 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6008
Practice Address - Country:US
Practice Address - Phone:323-566-4411
Practice Address - Fax:323-566-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A562732Medicaid
CA00A562732Medicaid
CAWA56273AMedicare PIN